."•"• tr*k» ••inmmhi;"■* 
 
 
 
MEDICAL  INQUIRIES

             i
              AND
OBSERVATIONS.
        BY BENJAMIN RUSH, M. D.

PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE AND OF CLINICAI
       PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA.


             ---



          FOUR VOLUMES IN TWO.



                vol. in.
THE FIFTH EDITION.
       PHILADELPHIA:


   PUBLISHED BY ANTHONY FINLEY,

NORTH EAST CORNER OF CBESNUT AND FOURTH STBEXTS

            1819. 
 
CONTENTS  OF VOLUME  III.
                                               pag&
OUTLINES of the Phenomena of Fever             1
An Account of the Bilious Yelloxu Fever, as it appear-
   ed in Philadelphia in 1793                        37
An Account of the Bilious  Yellow Fever, as it appear-
   ed in Philadelphia in 1794.                       195
An Account  of Sporadic  Cases of Bil'ous  Yellow
   Fever as they appeared in Philadelphia in 1795 and
   1796                                           219 
 
       OUTLINES






         OF THE








PHENOMENA OF FEVER.
VOL. III.
A 
 
           OUTLINES

               OF THE

PHENOMENA  OF  FEYER.
     AS many of the.diseases which are  the  subjects of
these volumes belong to the class of fevers, the following
remarks upon their phenomena are  intended to render the
principles and language I have adopted,  in the history of
their causes, symptoms, and cure, intelligible to the reader.
  I am aware that these outlines will suffer by being pub-
lished in a detached state from the general view of the
proximate cause of disease  which  I have taught  in my
lectures upon pathology, as well as from its being deprived
of that support which it would receive from being  accom-
panied  with  an account of the remedies for fever,  and the
times and manner of exhibiting them,  all  of which would
have served to illustrate and establish the facts and reason-
ings which are to follow upon this difficult and interesting
inquiry.
  I  shall not attempt  to give a definition of fever.  It
appears in so many different  forms,  that a  just  view  of  it
can only be given in a minute detail  of  all  of its symptoms
and states.
  In order to  render  the outlines  of fever, which  I am
about to deliver, more simple and intelligible, it  will be
necessary  to premise a few general propositions.
  I. Fevers of all kinds are preceded by  general debility.
This debility is natural or accidental.  The former is the
effect of the  sanguineous predisposition,  and exists  at all
times in many constitutions.    The latter is induced,
  1. By  such  preternatural  or unusual stimuli, as, after
first elevating the excitement of the system above its  heal-
thy grade, (and thereby wasting a part of its strengdi, or
what Dr. Brown calls  excitability,  and Darwin sensorial
power,) afterwards reduced it  down to that state which I
shall call debility of action. Or, 
4
OUTLINES OF  THE
  2. It is induced  by  such  an abstraction  of natural
stimuli  as to reduce the system below its healthy grade of
excitement, and thereby to induce what Dr. Brown calls
direct debility, but what I shall call debility from abstrac-
tion.  This general debility is the same, whether brought
on by the former or  the latter causes.   When induced by
the latter, the system becomes more excitable than when
induced by the former causes, and hence an attack of fever
is more frequently invited by it, than by that state of debi-
lity which succeeds the application of an undue portion of
stimulating powers.   To  this there is an exception, and
that is, when the remote causes of fever, act with so much
force and rapidity as suddenly to depress the system, with-
out an  intermediate elevation  of it,  and before sufficient
time is given to expend any part of its strength or excita-
bility, or to produce the  debility of action.   The system
in this state,  is exactly similar to that which arises from a
sudden  reduction of its healthy  excitement, by the abstrac-
tion of stimuli.  This debility from abstraction,  moreover,
is upon a footing with the debility from action, when  it is
of a chronic nature.   They both alike expend so much of
the quality  or substance of excitability,  as  to leave the
system  in a state in which irritants are seldom able to ex-
cite the commotions of fever, and when they do, it is of a
feeble nature, and hence we observe persons who have been
long exposed to debilitating  causes  of both kinds, often
escape fevers, while those who are recently debilitated, are
affected by them, under the same circumstances of expo-
sure to those causes.
  That fevers are preceded by general debility I  infer from
their causes, all  of which  act by reducing the excitement
of the system, by the abstraction of stimuli, or by their
excessive  or  unusual application.   The  causes  which
operate  in the former way are,
  1. Cold.  This is universally acknowledged to be a pre-
disposing cause of fever.    That it debilitates, I infer, 1.
From the languor which is observed in the inhabitants of
cold countries, and  from  the weakness which is  felt in
labour or exercise in cold weather.  2.  From the effects of
experiments, which  prove, that  cold  air and cold  water
Igssen the force and frequency of the pulse.
  % The debilitating passions of fear, grief, and despair. 
PHENOMENA OF  FEVER.
5
   3. All excessive evacuations, whether by the bowels,
blood-vessels, pores, or urinary passages.
   4. Famine, or the  abstraction of the usual quantities of
nourishing food.
   The causes which predispose to fever by the excessive
or unusual application of stimuli are,
   1. Heat.   Hence the greater frequency of fevers in warm
climates, and in warm weather.
   2. Intemperance in eating and drinking.
   3.   Unusual labour or exercise.
   4. Violent  emotions, and  stimulating passions of the
mind.
   5. Certain causes which act by  over-stretching a part,
or the  whole of the body, such as lifting heavy weights,
external violence acting mechanically in wounding, bruis-
ing, or compressing particular parts, extraneous substances
acting by their  bulk or gravity,  burning, and the like.*
The influence  of debility in  predisposing to fevers is fur-
ther evident  from their attacking  so often in the night, a
time when the system is more weak than at any other, in
the four and twenty hours.
   II.  Debility being thus formed in the system,  by the
causes which have  been enumerated, a sudden accumula-
tion of excitability takes place, whereby a predisposition is
created to fever.   The French writers  have lately called
this predisposition " vibratility,"  by  which  they mean a
liableness in  it  to be  thrown  into vibrations or  motions,
from pre-existing debility.  It is not always necessary that
a fever should follow this state of predisposition.  Many
people pass days and weeks under  it, without being attack-
ed by a fever, by carefully or accidentally avoiding the ap-
plication of additional stimuli or  irritants to their bodies:
but the space between  this state of predisposition, when it
is recent, and a fever, is a very small one;  for,  indepen-
dently of additional stimuli, the common impressions which
support life  sometimes become irritants, and readily add
another link to the chain of causes which induce fever, and
that is,
   III. Depression of the whole system, or what Dr. Brown
calls indirect debility.   It manifests  itself  in weakness
of the limbs,  inability  to  stand or walk without  pain,
* r'uUen's First Lines 
6                 OUTLINES  OF THE
or a sense of fatigue, a dry, cool, or cold skin, chilliness, a
shrinking of the hands and face, and a weak or quick pulse..
These symptoms characterize part of what I have called in
my lectures the forming state of fever.  It is not necessary
that a paroxysm of fever should follow this depressed state
of the system, any more than the debility that  has been de-
scribed.   Many people,  by rest, or by  means of gentle
remedies, prevent its formation; but where these are  ne-
glected, and the action of stimuli, whether morbid or natu-
ral, are continued,
   IV. Re-action is induced, and in this re-action, accord-
ing to  its greater  or less  force and extent, consist the dif-
ferent degrees of fever. It is of an irregular or a convulsive
nature.   In common cases, it is seated  primarily  in the
blood-vessels, and  particularly in the arteries.   These per-
vade every  part of the  body.  They  terminate upon its
whole surface, in which I include the lungs and alimentary
canal, as  well  as the skin.   They are the out-posts of the
system, in consequence of which they are  most exposed to
cold, heat, intemperance,  and all the other external,  and
internal, remote and exciting causes  of fever, and are  first
roused into resistance by them.
   Let it not  be thought, from these allusions, that I admit
Dr. Cullen's supposed vires naturae medicatrices to have
the least  agency in this re-action of the blood-vessels.   I
believe  it to  be  altogether the effect  of their elastic  and
muscular texture,  and that  it is as  simply  mechanical as
motion from impressions upon other kinds of matter.
   That the blood-vessels possess muscular fibres, and that
their irritability or disposition to  motion depends upon
them, has been demonstrated by  Dr. Vasschuer and Mr.
John Hunter,  by  many  experiments.   It has since been
proved by Spallanzani, in an attempt to refute it.   Even
Dr.  Haller, who denies the muscularity and  irritability of
the blood-vessels,  implies an assent to them in the follow-
ing words : " There are nerves which  descend for a long
way together through the surface of the artery, and at last
vanish in the cellular substance of the vessel,  of which we
have a specimen in the external and internal  carotids, and
in the arch of the aorta ; and from these do not the arteries
seem to derive a muscular and convulsive force very  dif-
ferent from that of their simple elasticity ?  Does not it show 
PHENOMENA OF  FEVER.
7
 itself plainly in fevers, faintings, palsies, consumptions,
 and passions of the mind?"*
   The re-action or morbid excitement of the arteries dis-
covers itself in  preternatural  force,  or frequency in their
pulsations. In ordinary fever, it is equally diffused through-
out the whole sanguiferous system, tor the heart and arte-
ries are  so  intimately connected, that, like the bells of the
Jewish high priest, when one of them  is  touched, they all
vibrate  in unison with each other.   To this remark there
are some  exceptions.
   1.  The arteries are sometimes affected with great morbid
excitement, while the natural functions of the heart are un-
impaired.    This occurs in those states of fever in which
patients are able to sit  up, and  even  to walk about, as in
pulmonary  consumption, and in hectic fever from  all its
causes.
   2.  The heart and pulmonary  artery are sometimes af-
fected with great morbid excitement,  while the pulsations
 of the arteries of the wrist are perfectly natural.
   3.  The morbid excitement of the  arteries is sometimes
 greater on one side of the body than on the other.  This is
 obvious in the difference in the  number and force of the
 pulsations in the different arms,  and  in the different and
 opposite appearances of the blood drawn from their veins,
 under equal circumstances.
   4.  The arteries in the head, lungs, and abdominal visce-
 ra are sometimes excited in a high  degree, while the arte-
 ries in  the extremities exhibit marks of a feeble morbid
 action.  Fevers attended with these and other deviations
 from their common phenomena,  have been  called by Dr.
 Alibert, ataxiques.   They occur most frequently in ma-
 lignant fevers.
   While  morbid excitement thus  pervades generally or
 partially the sanguiferous system, depression and debility
 are increased in  the alimentary canal, and in the nervous
 and muscular systems.   In  the  stomach,  bowels,  and
 muscles,  this debility is occasioned  by  their excitement
 being abstracted, and translated to the blood-vessels.
   I shall now endeavour to illustrate the propositions which
 have been  delivered, by taking notice  of the  manner in
* First Ljnes, sect. 32. of the chapter on Arteries 
a
OUTLINES OF  THE
 which fevers are produced by some of their most obvious
 and common causes.
   Has the body been debilitated by exposure to the cold
 air? Its excitability is  thereby  increased,  and  heat acts
 upon it with an accumulated force: hence the frequency
 of catarrhs, pleurisies, and other inflammatory fevers in the
 spring, after a cold winter:  and of bilious remittents in the
 autumn, when warm days succeed to  cold and damp nights.
 These diseases are seldom felt for the first time in the open
 air, but generally after the body has been exposed to cold,
 and afterwards to the heat of a warm room or a warm bed.
 Mild intermittents have frequently been observed to acquire
 an inflammatory type in the Pennsylvania hospital,  in the
 months of November and December, from the heat of the
 stove rooms acting upon bodies previously debilitated and
 rendered excitable by cold and disease.
  Has there been an abstraction of heat by a sudden shift-
ing of the wind from the south-west  to  the  north-west or
north-east points of the compass, or by  a cold night suc-
ceeding a warm day ? A fever is thereby frequently excit-
ed.   These  sources of fever occur every autumn in Phi-
ladelphia.  The miasmata which exist in the body at that
time in a harmless state, are excited  into action,  in a man-
ner to be mentioned presently, by  the debility from cold,
aided in the latter case by the inaction of sleep,  suddenly
induced upon the system.
  Again: has the body been  suddenly debilitated by la-
 bour or exercise ? Its excitement  is  thereby diminished,
but its excitability is increased in such a manner  that a full
meal, or an intemperate glass of wine, if taken immediately
after the fatigue is induced upon the body, excites a fever:
hence the frequency of fevers in persons upon their return
from hunting, surveying, long rides,  or from a camp life.
  But  how shall we account for the production of fever
 from the measles and small-pox,  which attack so uniform-
 ly, and without predisposing debility from any of its causes
 which have been  enumerated ? I answer, that the conta-
 gions of those diseases seldom act so  as to produce  fever,
 until the system is first depressed.  This is obvious from
 their being preceded by languor, and  all the other symp-
 toms formerly mentioned, which  constitute the forming
 state of fever.  The  miasmata which induce the plague and 
PHENOMENA OF  FEVER.               9
 yellow fever, when they are not preceded by the usual de-
 bilitating  and predisposing causes, generally induce the
 same depression of the system, previously to their exciting
fever.   Even wounds, and other local irritants, seldom in-
duce fever before they have first produced the symptoms
of depression formerly mentioned.   I shall presently men-
tion the exceptions to this mode of producing fever from
contagious miasmata and local injuries,  and show that they
do not militate against the truth of the  general proposition
that has been delivered.
 ' It may serve still further to  throw light upon this part of
our subject, to take notice of the difference between the ac-
tion of stimuli upon the body predisposed by debility and
excitability to fever, and their action upon it when there is
no such predisposition to fever,
  In health there is a  constant and just  proportion between
the degrees of excitement and excitability, and the force of
stimuli.   But this is not the case in a  predisposition to  a
 fever.  The  ratio between the action of stimuli and excite-
 ment, and excitability, is destroyed; and hence the former
 acts upon the latter with a force which produces irregular
 action,  or a  convulsion  in the arterial system.   When the
 body is debilitated, and its excitability increased, either by
 fear, darkness, or silence, a sudden  noise occasions a short
 convulsion.  We awake, in like manner, in a light convul-
 sion, from the sudden  opening of a door, or from the sprink-
 ling of a few drops of water in  the face, after  the  excitabili-
 ty of the  system has  been accumulated by a night's sleep.
 In a word, it seems to be a law of the system, that stimu-
 lus, in  an over-proportion to  excitability,  either produces
convulsion,  or goes so far beyond it, as to destroy motion
altogether in death.
  V. There is but one exciting cause of fever,  and that is
stimulus.   Heat, alternating with cold,* marsh and human
miasmata, contagions  and  poisons  of all kinds, intempe-
rance, passions of the mind, bruises, burns, and the like, all
act by a stimulating power only, in  producing fever.  This
proposition is of great application, inasmuch as it cuts the
  * Perhaps there is no greater enemy to the life of man than cold. Dr. Syden-
ham ascribes nearly all fevers to it, particularly to leaving off winter clothes
too soon, and to exposing the body to cold after it has been heated. These
sources of fever, lie adds, destroy more than the plague, sword, or famine.--i
D'allWs edition, vol. i. p 3J7.
  VOL. III.                 B 
10
OUTLINES OF  THE
sinews of the division of diseases from their remote causes..
Thus it establishes the sameness of a pleurisy, whether it
be excited by heat succeeding cold,  or  by the contagions
of the small-pox and measles, or by the miasmata of the
yellow fever.
  To this proposition there is a seeming objection.   Cold,
sleep, immoderate evacuations, and the debilitating passions
of grief and fear (all of which abstract excitement) appear
to induce, fever without the interposition of a stimulus.  In
all these cases, the sudden abstraction of excitement destroys
the  equilibrium of the system, by which means the blood
is distributed unequally,  and by acting  with an increase of
quantity and force  in  parts not accustomed to either, be-
comes an irritant to the blood-vessels, and thus a stimulat-
ing and exciting cause of fever.   When it is induced by
cold alone, it is probable  so much of the perspirable matter
may be retained as to co-operate, by its irritating qualities,
in exciting the fever.
  VI. There is but one  fever.  However different the pre-
disposing, remote,  or exciting  causes of fever may be,
whether debility from abstraction or action, whether heat
or cold succeeding  each other, whether marsh or human
miasmata, whether intemperance, a fright,  or a fall, still I
repeat, there can be but one fever.   I found this proposi-
tion upon all the supposed variety of fevers having but one
proximate cause.   Thus fire is a unit,  whether it be pro-
duced by friction,  percussion, electricity, fermentation, or
by a piece of  wood or coal in a state of inflammation.  I
infer the unity of fever further, from the sameness of the
products or effects of all its different forms.
  VII. All ordinary fever being seated in the blood-vessels,
it follows,  of course, that all those local affections we call
pleurisy, angina, phrenitis, internal dropsy of  the brain,
pulmonary consumption, and inflammation of the  liver,
stomach, bowels, and limbs,  are symptoms only of an ori-
ginal and primary disease in the sanguiferous system.  The
truth of this proposition is obvious,  from the above local
affections succeeding primary fever, and from their  alter-
nating so frequently with each other.   I except from this
remark  those  cases of  primary affections of the viscera
which are  produced by local injuries,  and which, after a
while, bring the whole sanguiferous system into sympathv. 
PHENOMENA  OF  FEyER.            11
 These cases are uncommon,  amounting, probably, to not
 more than one in a hundred of all the cases of local affection
 which occur in general fever.
   In my fourth proposition, I have called the action of the
arteries irregular in fever, to distinguish it from that excess
of action which takes place after violent exercise,  and from
that  quickness which accompanies fear or any other directly
debilitating cause.  The action of the arteries here is regu-
lar', and, when felt in the pulse, affords a very different sen-
sation from  that jerking which we feel in the pulse. of a
patient labouring  under a fever.
   In my lectures upon pathology, in which I have main-
tained the unity of disease, I have said  that it appears in
one or more of the following primary forms.  1. Spasm,
2. Convulsion,  3. Heat,  4. Itching, 5. Aura dolorifica, an(J
6. Suffocated excitement.  In ordinary fever, the second
form of morbid excitement, that is, convulsion, takes place
in the blood-vessels.  That this is the case I infer from the
 strict analogy between symptoms of fever, and convulsions
 in the nervous system.   I shall briefly mention the particu-
 lars  in which this analogy takes place.
   1. Are convulsions in the nervous system preceded by
 debility ? So is the convulsion of the blood-vessels in fever.
   2. Does debility, induced on the whole or on a part only
 of the nervous system,  predispose to general convulsions,
 as in tetanus ?  So we observe debility, whether it be indu-
 ced  on the whole or on  a part of the arterial system, predis-
 poses to general fever.  This is obvious in the fever which
 ensues alike from cold applied to every part of the body, or
from a stream of cold air falling upon the neck, or from the
wetting of the feet.
   3.  Do tremours precede convulsions in the nervous sys-
tem ?  So they do the convulsion of the blood-vessels in
 fever.
   4. Is a coldness in the extremities a precursor of con-
 vulsions in the nervous system ?  So it is of fever.
   6. Do convulsions in the nervous system impart a jerk-
 ing  sensation to  the fingers ?  So does the convulsion of
 lever in the arteries, when felt at the wrists.
   6. Are convulsions in  the nervous system attended with
 alternate  action and remission ?   So  is the  convulsion of
 fever. 
12
OUTLINES OF  THE
  7. Do convulsions in the nervous system return at regu-
lar and irregular periods ?   So does fever.
  8. Do convulsions in the nervous system, under certain
circumstances,  affect the functions of the brain ?   So do
certain states of fever.
  9. Are there certain convulsions in  the nervous system
which affect the limbs, without affecting the functions of the
brain, such as tetanus, and  chorea sancti viti ?  So there are
certain fevers, particularly the common  hectic, which sel-
dom produce delirium,  or  even head-ach, and frequently
do not confine a patient to his bed.
  10. Are there local convulsions  in the nervous system,
as in the hands, feet, neck,  and eye-lids ? So there are local
fevers.  Intermittents often appear  in the autumn, with pe-
riodical heat and pains in the eyes, ears, jaws,  and back.
  11. Are there certain grades in the  convulsions of the
nervous  system, as  appear in  the hydrophobia, tetanus,
epilepsy, hysteria, and hypocondriasis ?  So there are grades
in fevers, as in the plague,  yellow fever, small-pox, rheu-
matism, and common remitting and intermitting fevers.
  12. Are nervous convulsions most apt to occur  in in-
fancy ?  So are fevers.
  13. Are persons once affected with nervous convulsions
frequently subject to them  through life ?  So  are persons
once affected with fever. The intermitting fever  often re-
turns with successive springs or autumns, and, in spite of
the bark, sometimes continues for many years, in  all cli-
mates and  seasons.
  14.  Is the strength of the nervous system increased by
convulsions ?  This is so evident, that it often  requires four
or five persons to confine a delicate woman to  her bed, in  a
convulsive  fit.   In like manner the strength of the arterial
system  is increased in  a fever.    This strength is great in
proportion to the weakness of every other part of the body.
   15. Do we observe certain nervous convulsions to affect
some part of the nervous system  more than others,  or, in
other words, do we observe preternatural strength or ex-
citement to exist in  one part of the nervous system, while
other parts of the same system exhibit marks of preterna-
tural weakness or defect of excitement ? We observe the
same thing in the blood-vessels in a fever.   The pulse  at
the wrist is often tense, while the  force of the heart is very 
PHENOMENA  OF FEVER.
13
much diminished.   A delirium often occurs, in a  fever,
from excess of excitement in the blood-vessels of the brain,
while the pulse at the wrist exhibits every mark of preter-
natural weakness.
  16. Is there a rigidity of the muscles in certain nervous
diseases, as in catalepsey ? Something like this solstice in
convulsion occurs in that state of fever in which the pulse
beats but sixty, or fewer strokes in a minute.
  17. Do convulsions go off gradually from the nervous
system, as in tetanus, and chorea sancti viti ?   So they do
from the arterial blood-vessels in certain states of fever.
  18. Do convulsions go off suddenly  in  any cases from
the nervous system ? The convulsion in the blood-vessels
goes off in the same manner by a sweat, or by a haemorrh-
age, frequently in the course of a night, and sometimes in
a single hour.
   19.  Does palsy in some instances succeed to convulsions
in the nervous system ?  Something like a palsy occurs in
fevers of great inflammatory action in the arteries.  They
are often inactive in the wrists, and  in  other parts  of the
body, from  the immense pressure of the rerhote cause of
the fever upon them.
   From the  facts and analogies which have been mention-
ed,  I have been led to conclude that the common forms of
fever are occasioned simply by irregular action,  or convul-
sion in the blood-vessels.  This  irregular action is of two
kinds.  The first  is seated  in the  muscular fibres of the
blood-vessels themselves; the second consists in an irregu-
lar distribution of the blood  to different parts of the body,
particularly to the brain, lungs, liver and spleen.
   The history of the phenomena of  fever,  as delivered in
the foregoing pages, resolves itself into a chain,  consisting
of the five following links.
   1.  Debility from action,  or the abstraction of stimuli.
When this debility is induced by action, it  is  sometimes
preceded by elevated excitement in the blood-vessels, from
the first impressions of stimuli upon them.
   2. An increase of their excitability.
   3. Stimulating powers applied to them,
   4. Depression.   And,
   5. Irregular action or convulsion.
   The whole of the links of this chain are perceptible onh 
14               OUTLINES  OF THE
when the fever comes on in a gradual manner.  But I wish
the reader to remember, that the same remote cause is often
debilitating, stimulating, and depressing;  and that, in cer-
tain fevers,  the remote cause sometimes excites convul-
sions in the  blood-vessels, without being preceded by pre-
ternatural debility and excitability,  and with but little  or
no depression of the system. This has often been observed
in persons who have been suddenly exposed to those marsh
and human miasmata  which produce malignant fevers.  It
sometimes takes place likewise in fevers induced by local
injuries.   The blood-vessels in these cases are, as it were,
taken by storm, instead of regular approaches.
  I might digress here, and show that all diseases, whether
they be seated in the arteries,  muscles,  nerves, brain,  or
alimentary canal,  are all preceded  by debility;  and that
their essence consists in irregular action, or in the absence
of the natural order of motion, produced or invited by pre-
disposing debility.    I  might further show, that all the
moral, as well as physical evil of the world consists in pre-
disposing weakness, and in  subsequent derangement  of
action  or motion; but these collateral subjects are foreign
to our present inquiry.
  Let us now proceed to examine how far the facts  which
have been delivered accord with the phenomena of  fever.
  I shall divide these phenomena into two kinds.
  I. Such as are transient,  and more or less common to all
fevers.   These I  shall call symptoms of fever.
  II. Such as, being more permanent and fixed, have giv-
en rise to certain specific names.  These I shall call  states
of fever.
  I shall endeavour to explain and describe each of  them,
in the order in which they have been mentioned.
  I. Lassitude is the effect of the depression of the  whole
system, which precedes fever.
  The same cause,  when it acts upon the  extremities of
the blood-vessels, produces  coldness and chills. This is
obvious to  any person,  under the  first  impression  of the
miasmata which bring on fevers,  also under the influence
of fatigue,  and debilitating passions  of the mind.   The
absence of  chills indicates the sensibility of  the external
parts of the body to be suspended or destroyed, as well as
their irritability;  hence when  death occurs in the fit of an 
PHENOMENA  OF FEVER.              15
intermittent, there is no chill.  A chilly fit, for the same
reason, seldom occurs in the most malignant cases of fever.
  It is sometimes excited by blood-letting,  only because
it weakens those fevers to such a degree, as to carry the
blood-vessels back to the grade of depression.   Coldness
and chills are likewise removed by blood-letting, only be-
cause it enables the arteries to re-act in such a manner as
to overcome the depression  that  induced it.   It has been
remarked, that the chilly fit, in common fevers,  seldom
appears in its full force  until the patient approaches a fire,
or lies down on  a warm bed; for in these situations, sensi-
bility is restored by the stimulus of the heat acting upon
the extremities  of the  blood-vessels.  The first  impres-
sions of the rays of the sun, in like manner, often produce
coldness and chills in the torpid bodies of old and weakly
people.
   Yawning and stretching are induced by a disposition in
the system to overcome the uneasiness  which arises from
the contraction of the fauces, trachea, oesophagus and skin.
   Tremours are the natural consequence of the abstraction
 of that support  which the muscles receive from the fulness
 and tension of the blood-vessels.  It is from this retreat of
 the blood towards the viscera, that the capillary arteries lose
 their fulness and tension;  hence they contract,  like other
 soft tubes that  are emptied of their contents.  This con-
 traction has been called a spasm, and has improperly been
 supposed to be the proximate cause of fever.   From  the
 explanation that has been given of its cause, it appears, like
 the coldness and chills, to  be  nothing  but an  accidental
 concomitant, or effect of a paroxysm of fever.
   The local pains in the head,  breast, and bones in fever,
 appear to be the effects of  the  irregular determination of
 the blood to those parts, and to morbid action being there-
 by induced in them.
   The want of  appetite and costiveness are the consequen-
 ces of a  defect  of secretion of the gastric juice,  and  the
 abstraction of excitement or natural action from  the sto-
 mach and bowels.                                 •
   The  inability to  rise out of  bed, and to  walk, is  the
 effect of the abstraction of excitement  from the  muscles
 of the lower limbs.
   The dry skin or partial sweats appear to depend upon 
X<i
Outlines of the
 diminished or partial action in the vessels which terminate
 on the surface of the body.
   The high-coloured and pale urine are occasioned by an
 excess or a deficiency of excitement in the  secretory ves-
 sels of the kidneys.
   The suppression of the urine seems to  arise from what
 Dr. Clark calls an engorgement, or choaking of the vessels
 of the  kidneys.  It occurs most frequently  in malignant
 fevers.
   Thirst is probably the effect of a preternatural excitement
 of the vessels of the fauces.   It is by no means a uniform
 symptom of fever.   We sometimes observe it, in the high-
 est degree, in the last stage of diseases, induced by the re-
 treat of the last remains of excitement from every part of
 the body to the throat.
   The white tongue is  produced by  a change  in  the se-
 cretion which takes place in that organ.  Its yellow colour
 is the effect of bile; its  dryness  is occasioned  by  an ob-
 struction of secretion, or by the want of action  in  the ab-
 sorbents ; and its dark and black colour by a tendency to
 mortification.
   It will be difficult to account for the variety in  the de-
 grees and locality of heat in the body in a fever, until we
 know more of the cause of animal heat.   From whatever
 cause it be derived, its excess and deficiency, as well as all
 its intermediate degrees, are intimately connected with more
 or less excitement in the arterial  system.   It is  not neces-
 sary that this excitement  should exist  only  in the large
 blood-vessels.  It will be sufficient for  the purpose  of  cre-
 ating great heat, if it occur only in the cutaneous vessels;
hence we find a hot skin in some cases of malignant fever
 in which there is an absence of pulse.  It  is  a singular
 fact, that when the heat of the body is  12° and  13° above
 its natural temperature, patients have sometimes a sensation
 of cold.  This is taken notice of by Dr. De  Haen  and
Dr. Haller.  It is a fact likewise, that the body is sometimes
 cold, without the patient being sensible of it.  The sensa-
tion of cold is said by Dr. Grimaud to be  different in dif-
ferent forms of fever.  In catarrh, and  quotidian and quar-
tan fevers, the sensation he says is the same as that  of cold
air applied to the body; while in tertian and bilious  fevers
the sensation  resembles  that which is excited  by sharp 
PHENOMENA  OF FEVER.             17
points being thrust into the skin.   Is there  an increase in
the quantity of heat  in the whole body in a fever ? Or is
it, like excitement,  only  distributed  unequally? Experi-
ments alone can determine this question.
  Eruptions  seem to depend upon  effusions of  serum,
lymph, or red blood upon the skin, with or without inflam-
mation, in the cutaneous vessels.
  I decline  taking  notice in  this place of the symptoms
which are produced by the debility from action and abstrac-
tion, and by the depression of the system.   They appear
not only in the temperature of the body, but in all the dif-
ferent symptoms of fever.  It is of importance to know
when they originate from the former, and when from the
latter causes, as they sometimes require very different and
opposite remedies to remove them.
  It remains only to explain the cause  why excess in the
force or frequency of the action of the blood-vessels should
succeed  debility in  a part, or in  the whole  of the body,
and be connected for days and weeks  with depression and
preternatural debility in  the  nerves,  brain,  muscles, and
alimentary canal.  I shall attempt the explanation of this
phenomenon by directing the attention of the reader to the
operations of nature in other parts of her works.
  1.  A calm may be considered as a state of debility in
the atmosphere.  It predisposes to a  current of air.   But
is this current proportioned to the loss of the equilibrium
of the air ? By  no means.  It is excessive in  its force, and
tends thereby to destroy the works both of nature and art.
  2.  The passions are given to man on purpose to aid the
slow  and uncertain operations  of reason.   But is  their
action always proportioned to the causes which excite them?
An acute pneumony, brought on by the trifling injury done
to the system by the fatigue  and heat of an evening spent
in a dancing  assembly, is but a faint representation of the
immense  disproportion between a trifling affront, and that
excess of passion which  seeks for gratification in  poison,
assassination, or a duel.   The same disproportion appears
between cause and effect in public bodies.   A hasty word,
of no mischievous influence,  has often  produced convul-.
sions, and even revolutions, in states and empires.
  If we return to the human body we shall find in it many
other instances  of the disproportion between stimulus  and
  vol. hi.               c 
18
outlines of  the
 action, besides that which takes place in the excitement of
 fever.
   3.  A single castor oil nut, although rejected by the sto-
 mach upon its first effort in vomiting,  has, in one instance
 that came within my knowledge, produced a  vomiting that
 continued nearly four and twenty hours. Here the duration
 of action was far beyond all kind of proportion to the cause
 which excited it.
   4.  A grain of sand, after being washed from the eye, is
 often followed by such an inflammation or excess in the
 action of the vessels of the eye, as to require bleeding,
 purging, and blistering to remove it.
   Could we comprehend every part of the  sublime and
 ineffable system of the divine government, I am sure we
 should discover nothing in it but what tended ultimately
 to order.  But the natural, moral, and political world ex-
 hibit every where marks of disorder, and  the instruments
 of this disorder, are the operations of nature. Her influ-
 ence is most obvious in  the  production  of  diseases, and
 in her hurtful or  ineffectual efforts to remove them.* In
 again glancing at this subject I wish it to be remembered
 that those operations were  not originally the means of in-
juring or seducing man, and that I believe a time will come
 when the exact relation between cause and  effect, or, in
 other words, the dominion of  order shall be  restored over
 every action of his body  and mind, and health and happi-
 ness again be the result of every movement of nature.
   From  the view I have given of the state of the blood-
 vessels in fever, the reader will perceive the difference be-
 tween my  opinions and  Dr.  Brown's upon this  subject.
 The doctor supposes a fever to consist in  debility.   I do
 not admit debility to  be a disease, but place it wholly in
 morbid excitement, invited and fixed by previous debility.
 He makes  a fever  to consist in a  change only of a natural
 action of blood-vessels.   I maintain that it  consists in a
preternatural  and convulsive  action of the blood-vessels.
 Lastly,  Dr. Brown supposes excitement and  excitability
 to be equally diffused over the whole body, but in unheal-
 thy proportions to each other.  My theory places fever in
 excitement and excitability unequally diffused, manifesting

  * See the comparative View of the Diseases of the Indians and of Civilized
 Nations. Vol.  I. 
               PHENOMENA  of fever.             19

themselves, at the same time, in morbid actions, depression,
and debility from abstraction, in different parts of the body.
No new excitement from without is infused into the system
by the irritants which excite a fever.  They only destroy
its equal and natural distribution; for while the arteries are
in a plus, the muscles, stomach,  and bowels are in a minus
state of  excitement,  and the  business  of medicine is to
equalize it in the cure of fever,  that is, to abstract its ex-
cess from the blood-vessels, and  to  restore it to the other
parts of the body.
  II. I come now to apply what has been delivered to the
explanation and description of the different phenomena or
states of fever.
  I have said in my sixth proposition that there is but one
fever.   Of course I do not admit of its artificial division
into genera and  species.   A disease which so frequently
changes  its form and place, should never have been desig-
nated, like plants and animals, by unchangeable characters.
The oak tree and the lion possess exactly the same proper-
ties which they did nearly 6000 years ago.   But who can
say the same thing of any one  disease ?  The pulmonary
consumption is  sometimes transformed into a head-ach,
rheumatism, diarrhoea,  and mania, iff the course of two or
three months, or the same number of weeks. The bilious
fever often appears in the same person in the form of colic,
dysentery, inflammation of the liver, lungs, and brain, in
the course of five or six days.  The hypochondriasis and
the hysteria seldom fail to exchange their symptoms twice
in the four and twenty hours.  Again: the oak tree has not
united with any of the trees of the forest, nor has the lion
imparted his specific qualities to any  other animal.   But
who can apply  similar remarks to any one disease ?  Phre-
nitis, gastritis,  enteritis, nephritis, and rheumatism all ap-
pear at the same time in the gout and  yellow fever.  Many
observations of the same kind  might be made, to show the
disposition of nearly  all other diseases to anastomose with
each other.   To describe them therefore by any fixed or
specific  characters is as  impracticable as to measure the di-
mensions of a  cloud on a windy day, or to fix the compo-
nent parts of water by weighing  it in a hydrostatic balance.
Much mischief has been done by nosological arrangements
of  diseases.  They  erect imaginary boundaries between 
20
outlines of  the
 things which are of a homogeneous nature.  They degrade
 the human understanding, by substituting simple percep-
 tions to its more dignified operations in judgment and rea-
 soning.  They gratify indolence in a physician,  by fixing
 his attention upon the name of a disease, and thereby lead-
 ing him to neglect the varying state of the system.  They
 moreover lay a foundation for  disputes among physicians,
 by diverting their attention from the simple, predisposing,
 and proximate, to the  numerous, remote, and exciting
 causes of diseases, or to their more numerous, and compli-
 cated effects.   The  whole materia medica is infected with
 the baneful consequences of the nomenclature of diseases,
 for every article in it is pointed only against their names,
 and hence the origin of the numerous contradictions among
 authors who describe the virtues and doses of the same
 medicines.  By the rejection of the  artificial arrangement
 of diseases, a revolution must follow in medicine.  Obser-
 vation and judgment  will take the  place of reading and
 memory, and prescriptions will  be  conformed to existing
 circumstances.   The road to knowledge in medicine by
 this means will likewise be shortened; so that a young man
 will be able to qualify himself to practice physic at as much
 less expense of time and labour than formerly, as a child
 would learn  to read  and write by the help of the Roman
 alphabet, instead of Chinese characters.
  In thus rejecting the nosologies of the  schools, I do not
 wish to see them banished from the  libraries of physicians.
 When  consulted  as histories  of the effects of diseases
 only, they may still be useful.   I use the  term "diseases, in
 conformity to custom, for, properly speaking, disease is as
 much a unit as fever. It consists simply of morbid action
 or excitement in some part of the body.   Its different seats
 and degrees should no more be multiplied  into different
 diseases, than the numerous and different effects of heat and
 light upon our globe should  be multiplied into a plurality
 of suns.
  The advocates for Dr.  Cullen's system  of medicine, will
 not, I hope, be offended  by these observations.   His im-
 mense stock of reputation will  enable him to  sustain the
 loss of his nosology without being impoverished by it.  In
my attempts to introduce a new arrangement of fevers  I 
                PHENOMENA OF FEVER.             21

 shall only give a new direction to his efforts to improve the
 healing art.
   Were it compatible with the subject of the present inqui-
 ry, it would be easy to show, that the same difficulties and
 evils are to be expected from Dr. Darwin's division of dis-
 eases, as they affect the organs of sensation and motion, and
 as they are said to be exclusively related by association and
 volition, that have been deprecated from their divisions and
 subdivisions  by the nosologists.   Diseases, like vices, with
 a few exceptions, are necessarily undisciplined and irregu-
 lar.  Even the genius of  Dr. Darwin has not been able to
 compel them to  move within lines.
   I return from  this digression to remark,  that morbid ac-
 tion in the blood-vessels, whether it consist in preternatural
 force and frequency, or preternatural force without frequen-
 cy, or frequency without force, constitutes fever.  Excess
 in the force and frequency in the pulsations of the arteries
have been considered as the characteristic marks of what is
 called inflammatory fever.  There are, however,  symptoms
 which  indicate a much greater excess of irritating impres-
 sions upon the blood-vessels. These are preternatural slow-
 ness,  intermissions,  and depression in the pulse, such as
 occur in certain malignant fevers.
   But there  is a grade of fever,  which  transcends in force
 that which produces inflammation.   It  occurs  frequently
 in hydrophobia,  dysentery,  colic, and, baron  Humboldt
lately informed me,  upon the authority of Dr. Comoto, of
 Vera Cruz, in the yellow fever of that city, when it proves
fatal  in a few hours after it attacks.  In vain have physi-
cians sought  to discover, by dissections, the cause of fever
 in those cases, when followed by death, in the parts of the
 body in which it was supposed, from pain and other symp-
toms, to be principally seated. Those parts have frequently
 exhibited no marks of inflammation, nor of the least de
 viation from a healthy state.   I have ascribed this apparent
 absence of disease  to the serous vessels  being  too highly
 excited, and  thereby too much contracted, to admit the en-
 trance of red  blood into them. I wish these remarks to  be
 remembered  by the  student of medicine.   They have de-
 livered me from  the influence of several errors in pathology;
 and they are  capable, if properly extended and applied,  of 
22
OUTLINES OF  THE
leading to  many important deductions in the practice of
physic.
   I shall now briefly mention the usual effects of fever, or
morbid excitement in the blood-vessels, when not removed
by medicine.  They are,
   1. Inflammation."  It is produced by  an effusion of red
particles of blood into serous vessels, constituting what Dr.
Boerhaave calls error loci.   It is the second grade of fever,
and, in fevers of great violence, does not take place until
morbid excitement  has continued for some time, or has
been reduced by bleeding.
   2. Secretion, or an effusion from rupture,  of the serum
of the blood, constituting dropsies.  Under this head I in-
clude hydatids, which are found in every part of the body,
even in the heart.
   3. Secretion of lymph or  fibrin, forming a membrane
which adheres to certain surfaces in the body.
   4. Secretion of pus, sloughs,  and of a black matter, in
the stomach, liver, bowels, kidneys, and upon the skin.  In
the stomach it is called the " black vomit:"  upon {he skin
it forms what are called carbuncles.
   5. An effusion by rupture, or a congestion of all the
component parts of the blood.
   6. Gangrene from the death of the blood-vessels.
   7. Rupture of blood-vessels, producing haemorrhage.
   8. Redness, phlegmon, pustules, and petechia? on the
skin,  and tubercles  in the lungs, and on  the liver  and
bowels.
   9. Air.   How far this product of diseased action in the
blood-vessels may extend to every part of the body,  I know
not.   There can be no doubt of its being effused from the
stomach and liver into the bowels, in the paroxysms of bi-
lious fevers.
   10.  Schirrus, cartilage and bone.
   11.  Calcareous and other earthy matters.  The  two last
take place only in the feeble and often imperceptible grades
of morbid action in the blood-vessels.   Different  parts  of
the body are more or less disposed to produce the different
products of fever that have been  mentioned.
   12.  Death. This arises from the following causes.
   1. Sudden destruction of the  excitability of the blood-
vessels. 
PHENOMENA OF  FEVER.
23
  2. A disorganization of parts immediately necessary to
life.
  3. A change in the fluids, so as to render them destruc-
tive to what are called the vital organs.
  4. Debility,  from the exhausted or  suspended state of
the excitability of the blood-vessels.
  All these effects of fever  are  different according  to its
grade. Dr. Blane says fevers are rarely inflammatory  in the
West-Indies;  that is, they pass  rapidly from simple mor-
bid excitement to congestion, haemorrhage, gangrene, and
death.   This remark is confirmed  by Dr. Dalzelle,  who
says the pneumony in the negroes in  the French West-
India islands, rarely appears in any other form than that of
the notha,  from the arteries  in the  lungs being too  much
stimulated to produce common inflammation; but such is
the force of morbid excitement in  hot climates, that it
sometimes passes suddenly over all  its intermediate effects,
and discovers itself only  in death.   This  appears to have
taken place in the cases at Vera Cruz, mentioned by baron
Humboldt.  The  two extremes  of morbid excitement
seem to meet in a point, for  we sometimes observe death
to take place  from a feeble typhus fever  without leaving
behind it any marks of inflammation  or even serous effu-
sion, in common with the violent grade of fever which has
been described.
  All the different states of fever may be divided,
  I. Into  such as affect the  whole  arterial  system;  but
with no, or very little local disease.
   II.  Into such as affect the whole  arterial system, and are
accompanied at the same time with evident local disease.
   III. Into such as appear to pass by  the arterial system,
and to fix themselves upon other parts of the body. I shall
call these states of fever misplaced.
  I. To the first class of the states  of fever belong,
   1.  The malignant.   It constitutes the highest or worst
grade  of morbid  diathesis.  It is known by attacking fre-
quently without  a chilly fit, by coma, a depressed,  slow,
or  intermitting  pulse, and  sometimes  by the absence of
pain, and  with  a natural  temperature or coldness of the
skin.   It occurs in  the plague, in  the yellow fever,  in the
gout,  in the small-pox  and measles,  in the  hydrophobia,
and after taking opium and other  stimulating substances. 
 24                OUTLINES OF THE

 Dr. Quier has described a  pleurisy in Jamaica,  in which
 some of those malignant symptoms took place.   They are
 the effect of such a degree of impression as to prostrate
 the arterial system, and to produce a defect of action from
 an excess of force.  Such is this excess of force, in some
 instances, in this state of fever, that it induces general con-
 vulsions, tetanus, and  palsy, and sometimes extinguishes
 life  in  a few hours by means  of apoplexy or syncope.
 From its being accompanied with these symptoms, it has
 received the name of adynamique by Dr. Alibert.  The
 less violent degrees  of  stimulus in this state of fever pro-
 duce palsy in the blood-vessels.  It probably begins in the
 veins,  and extends  gradually  to the  arteries.   It seems
 further  to begin in the extremities of  the arteries,  and to
 extend  by degrees to  their  origin in  the  heart.   This is
 evident in the total absence of pulse which sometimes takes
 place in malignant fevers, four and twenty, and even eight
 and  forty hours before death. But there are cases in which
 this  palsy affects  both  the  veins  and arteries at  the same
 time.  It is probable  from  this  simultaneous affection of
the blood-vessels, that the arteries are  found to be nearly
full of blood after death from malignant fevers.   The de-
pressing and intermitting pulse which occurs in the begin-
ning of these fevers perhaps depends upon a tendency to
palsy in the arteries, independently of an affection of the
heart or brain.
   This prostrate state  of fever more frequently  when left
to itself terminates  in  petechias, buboes,  carbuncles, ab-
scesses, and mortifications, according as serum,  lymph, or
red blood is effused in the viscera or external parts of the
body.   These morbid  appearances have been ascribed to
putrefaction, and the fever has received, from its  supposed
presence, the name of putrid.  The existence of putrefac-
tion in the blood in a fever is rendered improbable.
   1. By Dr. Seybert's experiments,*  which prove that it
does not take place in the blood in a living state.  It occurs
 in the excretions of bile, faeces, and urine,  but in this case
it does not act as a ferment, but a stimulus only upon the
living body.
   2. By similar appearances, with those which have been

  * ^/"P™1 dissertation, entitled, « An Attempt to disprove the Putrefac-
tion of the Blood in Living Animals."                          v  l 
PHENOMENA  OF FEVER.
25
 ascribed to putrefaction, having  been produced  by light-
 ning, by violent emotions of the  mind, by  extreme pain,
 and by every thing else which induces sudden and univer-
 sal disorganization in the fluids and  solids of the body.
 The following facts clearly prove  that the symptoms which
 have  been supposed to  designate  a putrid fever,  are
 wholly the effect of mechanical action in the blood-vessels,
 and are unconnected with the introduction of a putrid fer-
 ment in the blood.
   Hippocrates relates the case of a certain Antiphillus,  in
 whom a putrid bilious fever (as he calls it) was brought on
 by the application of a caustic to  a wound.*
   An acute pain in the eye, Dr. Physick informed me, pro-
 duced the symptoms of what is called a putrid fever, which
 terminated in death in five days,  in  St. George's hospital,
 in the year 1789.
   Dr. Baynard  relates, upon the authority of a colonel
 Bampfield, that a stag, which he had chased for some time,
 stopped at a brook of water, in order to drink.  Soon after-
 wards, it fell and expired.  The colonel cut its throat, and
 was  surprised to  perceive the blood which issued from it
 had a putrid and offensive smell.f
   Dr. Dcsportes takes notice that a  fish, which he calls a
 sucker, affected the system  nearly in the same manner as
 the miasmata of the yellow fever.   A distressing vomiting,
 a  coldness  of the extremities, and  an absence of pulse,
 were some of the  symptoms produced by it; and an inflam-
 mation and mortification of the stomach and bowels,  were
discovered, after death, to be the  effects of  its violent ope-
 ration.
   Even opium, in large doses, sometimes produces, by its
powerful stimulus, the same symptoms  which are produced
by the stimulus of marsh miasmata.  These symptoms are
a  slow  pulse, coma, a vomiting, cold sweats, a sallow
 colour of the face, and a suppression of die discharges by
 the urinary passages and bowels.
   Error is often  perpetuated by  words.   A belief in the
 putrefaction of the blood has done great mischief in medi-
 cine.  The evil is kept up, under the influence of new the-
 ories, by the epithet putrid, which is still applied to fever.

     • Epidemics, book iv.           f Treatise on the Cold Bath.
   vol.  in.                 n 
26
OUTLINES OF  THE
in all our medical books.  For which reason  1  shall reject
it altogether, and substitute in its room—
  2. The gangrenous state  of  fever; for what appear to
some physicians to be signs of putrefaction, are nothing but
the issue of a violent inflammation left in the hands of na-
ture, or accelerated by stimulating medicines.   Thus the
sun, when viewed at mid-day, appears to the naked  eye,
from the excess of its splendour, to be a mass of darkness,
instead of an orb of light.
  The same explanation of what are  called putrid symp-
toms in fever, is very happily delivered by Mr.  Hunter, in
the following words: " It is to be observed (says this acute
physiologist) that when the attack upon these organs, which
are principally  connected  with life, proves fatal, that the
effects of the inflammation upon the constitution run through
all the stages with more rapidity than when it happens in
other parts; so that at its  very beginning,  it  has the same
effect upon the constitution which is only produced by the
second stage of inflammation  in other parts."*
  3. The synochus fortis state of fever is known by a full,
quick, and round pulse,  without tension.  The autumnal
bilious fever and colic, also the gout, often appear in  this
form.
  4. The synocha, or the common inflammatory state of
fever, attacks suddenly with chills, and is succeeded  by a
quick,  frequent, and tense pulse, great  heat,  thirst,  and
pains in the bones, joints, breasts, or sides.  These  symp-
toms sometimes occur in  the plague, the jail  and yellow
fever, and the small-pox ; but they are the more common
characteristics of pleurisy, gout, and rheumatism.  They
now and then occur in the influenza, the measles, and the
puerperile fever.
   5. There is a state of fever in which the pulse is small,
but tense and quick.  The patient, in this state  of fever, is
seldom confined to his bed.   We observe it sometimes' in
the chronic rheumatism, and in pulmonary consumption.
The inflammatory state of this grade of fever is proved  from
the inefncacy of the volatile tincture of guaiacum and other
stimulants to remove it, and  from  its vielding so suddenly
to blood-letting.   I  have called it the synochula state of
fever.
* Treatise on Inflammation, chap. I S 
PHENOMENA  OF  FEVER.
27
   6.  There is a state of fever inclining more to the synocha,
 than what is called the typhus, or low chronic state of fever.
 I have called it the synochoid state of fever.
   7.  The synbchus mitis, or mild bilious, and intermitting
 states of fever.
   8.  The typhus state of fever is generality preceded by all
 those circumstances which debilitate the system, both by
 the action  and abstraction of stimuli.   It is known  by a
 weak and frequent pulse, a disposition to sleep, a torpor of
 the alimentary canal, tremours of the hands, a dry tongue,
 and,  in some instances,  by a diarrhoea.  These symptoms
 occur most frequently in what is called the jail, the  ship,
 and the hospital fever.   I heard of it in a few cases in the
 yellow fever of 1793 ; and all writers take notice of cases of/
 the plague, which run on into a slow fever that  continues
 30 or 40 days.  I  have seen it succeed the common bilious
 fever, pleurisy, and influenza.  It has been confounded with
 the malignant state of fever,  or  what is called the typhus
 gravior; but it differs widely from it in  being accompanied
 for the most part by a feeble excitement  in the blood-vessels
 from a feeble stimulus, and  by the usual signs of debility
 from abstraction in every other part of the body.
   From the accession of new stimuli, or an increase in the
 force of former ones, this typhus state  of fever sometimes
 assumes, on the 11th, 14th,  and even 20th days, the symp-
 toms of  the synocha state of fever.   It will be  useful to
 remember this remark, not  only because it establishes the
 unity of fever, but because it will justify the use of a re-
 medy, seldom prescribed after the disease has acquired that
 name which associates it with stimulating medicines.
   The common name of this state of fever, is the nervous
fever.  This name is improper;  for it invades the nervous
 system by pain, delirium, and convulsions, much less than
 several other states  of fever.   To prevent the absurd and
 often fatal association of ideas  upon the treatment of this
 state of fever, I have called  it, from  its duration, the low
 chronic state of fever.   I have adopted  the term low, from
 Dr. Butter's account of the  remitting fever of children, in
 order to distinguish it from states of fever to be mentioned
 hereafter, in which the patient is not confined to his  bed.
 This new name of the typhus or nervous fever establishes
 its analog)' with several other diseases.  We have  the acute 
28                OUTLINES  OF THE
and the chronic rheumatism;  the acute and chronic pneu-
mony, commonly called  the  pleurisy and pulmonary  con-
sumption ; the acute and chronic inflammation of the brain,
known unfortunately by  the  unrelated names of phrenitis,
madness, and internal dropsy of the brain.  Why should
we hesitate, in like manner, in admitting acute  and chronic
fever, in all  those cases where no local inflammation at-
tends?
   9. The typhoid state of fever is composed of the syno-
cha and low chronic states of fever.  It is the slow nervous
fever of Dr. Butter.   The excitement of the blood-vessels
is  somewhat greater than in the low chronic state of fever.
Perhaps the muscular  fibres  of the blood-vessels, in this
state of fever, are affected by  different degrees  of stimulus
and excitement.  Supposing a pulse to  consist of  eight
cords,  I think I have frequently felt more or less of them
tense  or relaxed, according as  the fever partook more  or
less of the synocha, or low chronic states of fever.  This
state of fever  occurs most frequently in what are called the
hectic and puerperal fevers, and in the scarlatina.
   10. The hectic state of fever differs from all the  other
states of fever, by the want of regularity  in its paroxysms,
in  which chills, fevers, and sweats are included;  and by
the brain, nerves, muscles,  and  alimentary canal being but
little impaired in their functions by it.  It appears to be an
exclusive disease of the  blood-vessels.   It occurs in the
pulmonary  consumption, in some cases  of lues, of scro-
fula, and of the gout, and  after most of the states of fever
which have been described.  The force of the pulse is va-
rious, being occasionally synochoid, typhoid, and  typhus.
   11.  Intermissions,  or  the intermitting  and remitting
states of fever, are common to all the states of  fever which
have been mentioned.  But they occur most distinctly and
universally in those which partake of the bilious diathesis.
They have been ascribed to the reproduction of bile, to the
recurrence of debility, and to the influence of the heavenly
bodies upon  the system.   None  of tliese hypotheses has
explained the recurrence of fever,  where the bile  has not
been in fault, where debility is uniform,  and where the pa-
roxysms of fever do not accord  with the revolutions of anv
part of the solar system.  I have endeavoured to account
for the recurrence of the paroxysm of fever,  in common 
PHENONEMA
OF  FEVER.
29
 with all other periodical diseases,  by means of a natural or
 adventitious  association of  motions.   Dr.  Percival  has
 glanced at this law of animal  matter; and Dr. Darwin has
 explained by it, in the most ingenious manner, many natu-
 ral and morbid actions in the  human body.
   12. There is a state of fever in which the morbid action
 of the blood-vessels is so feeble as scarcely to be percepti-
 ble.   Like the hectic state of fever, it seldom affects the
 brain, nerves, muscles, or alimentary canal.  It is known
 in the southern states of America  by the  name of inward
 fevers.   The English physicians formerly described it by
 the name of febricula.
  These twelve states of fever may be considered  as pri-
 mary in their  nature.  All the states which remain to be
 enumerated belong»to some one of them, or they are com-
 pounds  of two,  three, or more  of them.   Even these pri-
 mary states of fever seldom appear in the simple form in
 which they have been described.  They often blend  their
 symptoms ; and sometimes all the states appear at different
 times in the course  of a fever.  This departure  from a
 uniformity in the character of fevers must be sought for in
 the changes of the weather, in the casual application of fresh
 irritants, or in the operation  of the  remedies which  have
 been employed to cure them.
  To the first class of the states of fever belong the sweat-
 ing,  the fainting, the burning, and the cold and chilly states
 of fever.
  13. The sweating state of fever occurs in the plague, in
the yellow fever, in the  small-pox, the pleurisy, the rheu-
 matism, and  in the hectic and intermitting states of fever.
 Profuse sweats appeared every other day in the autumnal
fever of 1795 in Philadelphia, without any other symptom
of an intermittent.   The English sweating sickness was
nothing but a symptom of the plague.  The sweats in all
these oases are the effects of morbid and excessive action,
 concentrated in the capillary vessels.
  14. The fainting state of fever accompanies the plague,
 the yellow fever, the small-pox, and some states of pleuri-
 sy.   It  is the effect of great depression ; hence it occurs
 most frequently in the beginning of those states of fever.
  15. The burning state of fever has  given rise to  what
has been called a species of fever.   It is the causus of au- 
30
OUTLINES OF  THE
thors. Dr. Mosely, who rejects the epithet of yellow, when
applied to the bilious fever, because it is only one  of its
accidental symptoms, very improperly distinguishes the
same fever by another symptom, viz. the burning heat of
the skin, and which is not more universal  than the yellow-
ness which attends it.
  16. The cold and chilly state of fever differs from a com-
mon chilly fit, by continuing four or five days, and to such
a degree, that .the  patient frequently cannot bear his arms
out of the bed.  The coldness is most obstinate in the
hands and feet. A coolness only of the skin attends in some
cases, which is frequently mistaken for an absence of fever.
  In mentioning those states of fever which affect the arte-
rial system without any, or with but  little local  disease, I
wish to be understood that  they do  not affect that system
only.   On the contrary,  they bring the nerves,  muscles,
lymphatics, and brain more or less into  sympathy with it.
The last suffers most from those fevers  which are derived
from miasmata,  and  contagions, in consequence of their
jxassing directly in most cases, from the nose to the brain.
I proceed next to enumerate those states of fever which be-
long to  the—
  II.  Class of the order that was mentioned, in which there
are  local affections combined with general fever. They are—
  17. The intestinal state of fever.  I have been anticipat-
ed in giving this  epithet to fever, by Dr. Balfour.*  It in-
cludes the cholera morbus,  diarrhoea, dysentery,  and colic.
The remitting bilious fever appears, in all the above forms,
in the summer months.  They all belong to  the febris in-
troversa of Dr. Sydenham.  The jail fever appears likewise
frequently  in the form of  diarrhoea and dysentery.   The
dysentery is the offspring of marsh  and human  miasmata,
but it is often induced in a weak state of the bowels,  by
other exciting causes.   The colic occasionally occurs with
states of fever to be mentioned hereafter.
   18. The pulmonary state of fever includes the true and
bastard pneumony in their acute forms; also catarrh from
cold and influenza, and the chronic form  of pneumony in
what is called pulmonary consumption.
   19. The eruptive state of fever includes the small-pox,
* Account of the Intestinal Remitting Fever of Bengal. 
PHENOMENA  OF FEVER.
31
measles, erysipelas, military fever, chicken-pox, and pem-
phigus.
  20.  The anginose state of fever includes all those affec-
tions of the throat which  are  known by the names of cy-
nanche inflammatoria, tonsillaris, parotidea, maligna,  scar-
latina,  and trachealis.   The cynanche trachealis is a febrile
disease.   The membrane which produces suffocation and
death in the wind-pipe is the  effect of inflammation.  It is
said to be formed, like  other membranes which succeed
inflammation,  from the coagulable lymph of the blood.
  21.  The rheumatic state of fever is confined chiefly  to
the labouring  part of mankind.  The  topical affection is
seated  most commonly in  the joints and  muscles, which,
from being exercised more than other parts  of die body,
become more debilitated, and are, in consequence thereof,
excited into morbid and  inflammatory action.
  22.  The arthritic or gouty state of fever differs from the
rheumatic, in affecting, with the joints and muscles, all the
nervous and lymphatic systems, the  viscera,  and  the skin.
Its predisposing, exciting, and  proximate causes are  the
same as the rheumatic and other states of fever.   It bears
the same  ratio to rheumatism, which the yellow fever bears
to the common  bilious fever.  It is a fever of  more force
than rheumatism.
   23.  The cephalic,  in  which are included the phrenitic,
lethargic,  apoplectic, paralytic, hydrocephalic, and maniacal
states  of  fever.   That  madness  is  originally a state of
fever,  I infer, 1.  From its causes, many of which are  the
same as those which induce all the other states  of fever. 2.
From  its  symptoms, particularly a  full, tense,  quick,  and
sometimes a slow pulse.  3. From the inflammatory appear-
ances  of  the  blood which has  been drawn  to relieve it.
And, 4. From the phenomena  exhibited by dissection in
the brains of maniacs, being the same as  are exhibited by
other inflamed viscera after death.   These are,  effusions of
water  or blood, abscesses, and schirrus.  The  hardness in
the brains of maniacs, taken notice of by  several  authors,
is nothing but a schirrus (sui generis), induced by the ne-
glect of sufficient evacuations in this state of fever.  The
reader will  perceive  by these observations,  that  1  reject
madness from its supposed  primary seat  in  the  mind  or
nerves.   It is as much an original disease of  the blood- 
32
OUTLINES OF  THE
 vessels, as any other state of fever.   It is to phrenitis, what
 pulmonary  consumption is  to  pneumony.  The derange-
 ment in the operations of the mind is the  effect only of a
 chronic inflammation  of the  brain, existing  without an
 abstraction of muscular excitement.
   24.  The nephritic state  of  fever,  is often induced  by
 calculi, but it frequently occurs in the gout, small-pox, and
 malignant states of fever.  There is such an engorgement,
 or choaking of the vessels of the kidneys, that the secre-
 tion of the urine is sometimes  totally obstructed, so that
 the bladder yields  no water to the catheter.   It  is generally
 accompanied with  a full or tense pulse, great pain, sickness,
 or vomiting, high coloured  urine, and  a pain along the
 thigh and leg, with ccasionally  a  retraction of  one of the
 testicles.   It exists sometimes without any pain.  Of this
 I met with several instances in the yellow fever of 1793.
 I include diabetes  in this state of fever.
   25. The hydropic state of fever,  in which are included
 collections  of water,  in the lungs,  cavity of the thorax,
 cavity of the abdomen, ovaria, scrotum, testicles, and lower
 extremities, and usually preceded, and generally accompa-
nied with morbid action in the blood-vessels.  That dropsy
 is a state  of fever, I have endeavoured to prove in another
place.*   Nineteen dropsies out of twenty appear  to  be
original arterial diseases, and  the water, which has been sup-
posed to be their cause, is as much the effect of preternatural
and morbid action in the blood-vessels, as pus, gangrene,
and schirrus are of previous inflammation. This has been
demonstrated, by the late Dr. Cooper, in a man who died
of an ascites in the Pennsylvania hospital.   Pus and blood,
as well as water, were found in  the cavity of the abdomen.
It is no objection to this theory of dropsy, that we some-
times find water in  the  cavities of  the  body after death,
 without any marks of inflammation in the contiguous blood-
 vessels.   We often  find pus, both in the living and dead
 body, under the same circumstances, where we are sure it
 was not preceded by any of the obvious marks of inflam-
 mation.
   26. The hemorrhagic state of fever, in which are includ-
 ed  discharges of  blood from  the  nose, lungs,  stomach,
 iver, bowels, kidneys, and bladder, haemorrhoidal vessels.
                    * On Dropsies, Vol. II. 
PHENOMENA OF  FEVER.
33
and skin.   Haemorrhages have  been divided  into active
and passive.   It  would be  more  proper to divide them,
like  other  states  of general fever,  into  haemorrhages of
strong and feeble  morbid action. There is seldom an issue
of blood from a vessel, in which there does not exist pre-
ternatural or accumulated excitement.   VV e observe  this
haemorrhagic state of fever  most  frequently in malignant
fevers, in pulmonary consumption, in pregnancy, and in
that period of life in which the menses cease to be regular.
   27.  The amenorrhagic state of  fever  occurs more  fre-
quently than is suspected by physicians.   A full and quick
pulse, head-ach, thirst, and preternatural  heat often accom-
pany a chronic obstruction of the menses.  The inefficacy,
and even hurtful  effects, of what  are called emenagogue
medicines, in this state of the system, without previous de-
pletion, show the propriety of introducing it among the dif-
ferent states of fever.
   I have designedly omitted to take notice  of  other states
of general fever  accompanied with local disease,  because
they are most frequently combined with  some one or more
of those which have been mentioned.   They  may all be
seen in Dr. Cullen's Synopsis, with their supposed respec-
tive generic characters, under the class of pyrexiae, and the
order of fevers.   We  now come, in the—
   III. And last place, to mention the misplaced states of
fever.  The term is not a new one in medicine. The gout
is said to be misplaced, when it passes from the feet to the
viscera.   The  periodical pains in the  head,  eyes,  ears,
jaws, hips,  and back, which occur in the sickly autumnal
mondis, and which impart no fulness, force, nor frequency
to the pulse, are all misplaced fevers.   There are, besides
these,  many other local  morbid affections, which are  less
suspected of belonging to febrile diseases.  The nature of
these states of fever may be understood, by recollecting
one of the laws of sensation, that is, that certain impres-
sions, which excite neither sensation nor motion in the part
of the body to which they are applied, excite both in an-
other part.  Thus worms, which are not felt in the stomach
or bowels,  often produce a troublesome sensation in the
throat; and a stone, which is attended with no pain in the
bladder, produces a troublesome itching in the glans penis.
   vol.  in.               f. 
'34                OUTLINES OF  THE

In like manner, die irritants which produce fever in ordi-
nary cases pass through the blood-vessels, and convey their
usual morbid effects into a remote part of the body, which
has been  prepared to  receive them by  previous debility.
That this is the case, I  infer further, from  fevers being
called back from their misplaced  or suffocated situations,
by creating an artificial debility in the arteries by the  ab-
straction of blood.  This is often done in muscular convul-
sions, and in several diseases of the brain.
   Under this class of fevers are  included—
   28.  The chronic hepatic state of fever.   The causes,
symptoms, and remedies of the liver disease of the East
Indies, as mentioned by Dr. Girdlestone, all prove that it
is nothing but a bilious fever translated from the blood-
vessels, and absorbed, or suffocated, as it were, in the liver.
This view of the chronic hepatitis is important,  inasmuch
as it leads to the liberal use of all the remedies which cure
bilious fever.  Gall stones  and contusions now and then
produce a hepatitis; but under no other  circumstances  do
I believe it ever exists, but as  a  symptom  of general or
latent fever.
   29. The haemorrhoids are frequently a local disease, but
they are sometimes accompanied with pain, giddiness, chills,
and an active  pulse.   When these symptoms occur, it
should be considered as a' hemorrhoidal state of fever.
   30. The opthalmia, when it occurs, as it frequendy does
in sickly seasons,  with a quick and tense pulse, and  pains
diffused over the whole head, may properly be called an
opthalmic state of fever.                  I
   31.  The tooth-ach,  and—
   32.  Ear-ach, when they arise from colds, and are attend-
ed with great heat, a  quick and tense pulse, and  pains in
the head, are odontalgic and otalgic states of fever.
   33.  The apthae, from the pain  and fever  which attend
them, are justiy entitled to the name of the apthous state
of fever.
   34.  The  symptoms of  scrofula,  as described by Dr.
Handy, in his treatise on  the glandular disease of Barba-
dpes, clearly prove it to be a misplaced state of fever.
  35. The scurvy has lately been proved by Dr. Claiborne,
in his inaugural dissertation,  published in the year 1797
to arise from so many of the causes, and to possess  so 
PHENOMENA OF  FEVER.
35
many of the symptoms, of the low chronic and petechial
states of fever, that  I see no impropriety in considering it
as a state of fever.
   36. The convulsive or spasmodic state of fever.   Con-
vulsions, it is well known,  often usher in fevers,  more  es-
pecially in children.   But the connexion between spasmo-
dic affections and fever, in adults, has been less attended to
by physicians.   The same causes which produced general
fever and hepatitis in the East Indies, in some soldiers, pro-
duced locked jaw in others.   Several of the symptoms of
this disease, as described by Dr. Girdlestone, such as cold-
ness on the surface of the body, cold sweats on the hands
and feet, intense thirst, a white tongue, incessant vomitings,
and carbuncles, all belong to the malignant state of fever.*
By means of blood-letting, and the other remedies for the
violent state of bilious fever, I have seen the convulsions in
this disease translated from the muscles to the blood-vessels,
where they immediately produced all the common symp-
toms of fever.
   37. The hysterical and hypochondriacal states of fever.
The former is known by a rising in the throat, which is for
the most part erroneously ascribed to worms, by pale urine,
and by a disposition to shed tears, or to laugh upon trifling
occasions.   The latter discovers itself by false opinions of
the nature and danger of the disease under which the patient*
labours.  Both these states of the  nervous  system occur
frequently in the gout, and in the malignant  state of fever.
It is common to say, in such  cases, that  patients have a
complication of diseases; but this is not true, for the hys-
terical and hypochondriacal symptoms are nothing but the
effects of one remote cause,  concentrating its force chiefly
upon the nerves and muscles.
   38. The cutaneous state of fever.  Dr. Sydenham calls
a dysentery  a " febris introversa."—Eruptions of the skin
are often nothing but the reverse of this' introverted fever.
They are a fever translated to the skin; hence we find them
most common in those countries and seasons in which  fe-
vers are epidemic.   The  prickly heat, the rash, and the
essere of authors, are all  states of misplaced fever.  " Agues,
fevers, and  even pleurisies,  (says  Mr.  Townsend, in his
Journey through Spain,j) are  said often to terminate in
       • Essay on the Spasmodic AflTedions in India, p 5."?, 54,6$.
       t Vol. H. Dublin edition, p. '262 
36
OUTLINES, &C.
scabies, and this frequently gives place to them, returning,
however, when the fever ceases.  In adults, it takes posses-
sion of the hands and arms, with the legs and thighs,  co-
vering them with a filthy  crust."  Small biles are common
among the children in Philadelphia, at the time the cholera
infantum  makes its appearance.   These  children  always
escape the summer epidemic.  The elephantiasis described
by Dr. Hillary, in his account of the diseases of Barbadoes,
is evidently  a  translation  of an intermittent to one of the
limbs.  It is remarkable, that  the  leprosy  and  malignant
fevers of all kinds  have appeared and declined together in
the same ages  and countries.  But further, petecliiae some-
times appear on the skin without fever. Cases of this kind,
with and  without haemorrhages, are taken notice of by
Riverius,* Dr. Duncan,  and many other practical writers.
They are cotemporary or subsequent to fevers of a malig-
nant complexion.   They occur likewise  in the scurvy.
From some of  the predisposing, remote, and exciting causes
of this disease, and from its symptoms  and remedies,  I
have suspected it, like the petechias mentioned by Riverius,
to be originally a fever generated by human miasmata, in a
misplaced state.   The haemorrhages which sometimes ac-
company the scurvy, certainly arise from a morbid state of
the blood-vessels.  The  heat and quick pulse of fever are
probably absent, only because the preternatural excitement
of the whole sanguiferous system is  confined to those  ex-
treme or cutaneous vessels which pour forth blood.  In like
manner the fever of the small-pox deserts the blood-vessels,
as soon as a new action begins on the skin.  Or perhaps
the excitability of the larger blood-vessels may be so far
exhausted by the long or forcible impression of the remote
and predisposing causes of the scurvy, as to be incapable of
undergoing the convulsive action of general fever.
   With this I close the history of the phenomena of fever.
It is imperfect  from its brevity, as well as from other causes,
I commit it to my pupils, to be corrected and improved.

          " We think our fathers fools, so wise we grow,
          " Our wiser sons, I hope, will think us so."
* Praxis Medica, lib. xviii. cap. i. 
             4N ACCOUNT





                OP THE





BILIOUS REMITTING YELLOW FEVER,





                 AS IT





       APPEARED IN PHILADELPHIA,




            /.TV THE YEAR 1793. 
 
AN ACCOUNT,  &c.
    BEFORE I proceed to deliver the history of this fe^
ver, it will be proper to give a short account of the diseases
which preceded it.
  The state of the weather during the first seven months of
the year, and during the time in  which the fever prevailed
in the city, as recorded by Mr. Rittenhouse, will be insert-
ed immediately after the history of the disease.
  The mumps, which made their appearance in December,
1792, continued to prevail during  the month of January,
1793.   Besides this disease, there were many cases of ca-
tarrh in the city, brought on chiefly by the inhabitants ex-
posing themselves  for several hours on the damp ground,
in viewing the aerial voyage of Mr. Blanchard, on the 9th
day of the month.
  The  weather, which had been moderate in December
and January, became cold in February.   The mumps con-
tinued to prevail during this month with symptoms so in-
flammatory as to require, in  some  cases, two bleedings.
Many people complained tiiis month of pains and swellings
in the jaws.  A few had the scarlatina anginosa.
  The mumps,  pains in the jaws, and scarlatina continued
throughout the month of March. I was called to two cases '
of pleurisy in this month, which terminated in a temporary
mania.  One of them was a woman of ninety years of age,
who recovered. The blood drawn in the other case (a gen-
tleman from Maryland) was dissolved.   The continuance
of a tense pulse induced me, notwithstanding, to repeat the
bleeding.   The blood was now sizy.  A third bleeding
was prescribed, and my patient recovered.  Several cases
of obstinate erysipelas succeeded  inoculation in children
during this and the next month, one of which proved  fatal.
   Blossoms were universal on the fruit-trees, in the gardens
of Philadelphia, on the first day of April.  The scarlatina 
40              AN ACCOUNT OF THE

anginosa continued to  be the reigning epidemic in this
month.
  There were several warm days in May, but the city was
in general healthy.   The birds appeared two weeks sooner
this spring than usual.
  The register  of the weather shows that there  were many
warm days  in June.  The scarlatina continued  to maintain
its empire during this month.
  The weather  was uniformly warm in July.   The scarla-
tina continued during the beginning of this month, with
symptoms of great violence.   A son of James  Sharswood,
aged seven  years, had, with the common symptoms of this
disease, great pains and swellings in his, limbs, accompa-
nied with a tense pulse.  I attempted in vain to relieve him
by vomits and purges.   On the 10th day of the month,  I
ordered six ounces of blood  to be  drawn  from  his arm,
which  I observed  afterwards  to be very sizy.   The next
day he was nearly well.  Between the 22d and the 24th
days of the  month, there died three persons,  whose respec-
tive ages were 80,  92, and 961.   The weather at this time
was extremely warm.  I have elsewhere taken notice of the
fatal influence of extreme heat, as well as cold, upon human
life in old people.   A few bilious remitting fevers appeared
towards the close  of this month.   One of them under my
care ended in a typhus or chronic fever, from which the
patient was recovered with great difficulty.   It  was the son
of Dr. Hutchins,  of the island of Barbadoes.
  The weather, for the first two or three weeks in August,
was temperate and pleasant.  The cholera morbus and re-
mitting fevers were now common. The latter were attend-
ed with some inflammatory action in the pulse, and a de-
termination  to the  breast.  Several dysenteries  appeared at
this time, both in the city and in its  neighbourhood. Dur-
ing the latter part  of July, and the beginning of this month
a number of the distressed inhabitants of St. Domingo, who
had escaped the desolation of fire and sword, arrived in the
city.   Soon after  their arrival,  the influenza made its ap-
pearance,  and spread rapidly among our citizens.   The
scarlatina still kept up  a feeble existence among children.
The above diseases were universal,  but they were not at-
tended with much mortality.  They  prevailed  in  different
parts of the city, and each appeared occasionally  to  be the 
BILIOUS YELLOW FEVER OF 1793.        41
ruling epidemic.  The weather continued to be warm and
dry.   There was a heavy rain on the twenty-fifth of the
month, which  was remembered by the citizens of Phila-
delphia, as the  last that fell for many weeks afterwards.
  There  was  something in  the  heat and drought of the
summer months which was uncommon,  in their influence
upon the human body.  Labourers every where gave out
(to use the country phrase) in harvest, and frequently too
when the mercury in Fahrenheit's thermometer was under
84°.   It was ascribed by the country people to the calm-
ness  of the weather, which left the sweat produced by heat
and labour to dry slowly upon the body.
  The crops  of grain  and  grass were  impaired  by the
drought.   The summer fruits were as plentiful as usual,
particularly the melons, which were of an excellent quality.
The  influence  of the weather upon the autumnal fruits, and
upon vegetation in general shall be mentioned hereafter.
  I now  enter upon  a detail of some solitary cases of the
epidemic, which  soon afterwards spread  distress through
our city,  and terror throughout the United States.
  On the 5th  of August, I was requested by Dr. Hodge
to visit his child.   I found it ill with a fever of a bilious
kind, which terminated (with a  yellow skin) in death on
the 7th of the  same month.
  On the 6th of August,  I was called to Mrs. Bradford,
the wife of Mr. Thomas Bradford. She had all the symp-
toms of a bilious remittent, but they were so acute as to
require two bleedings, and several successive doses of phy-
sic.  The last  purge she took was a dose of calomel, which
operated plentifully.  For several days after her recovery,
her eyes and face were of a yellow colour.
  On the same day, I was called to the son of Mrs. M'Nair,
who had been  seized violently with all the usual symptoms
of a bilious fever.  I purged him plentifully  with salts and
creamor tartar, and took ten or twelve ounces of blood from
his arm.  His  symptoms appeared to yield to these reme-
dies ; but on the 10th of the month an haemorrhage from the
nose came on,  and on the morning of the 12th he died.
  On the 7th  of  this month I was called to visit Richard
Palmer, a son of Mrs. Palmer, in  Chesnut-street.  He  had
been indisposed for several days with a sick stomach,  and
vomiting after  eating.   He now complained  of a fever  and
  vol. hi.               F 
42              AN ACCOUNT OF THE
head-ach.  I gave him the usual remedies  for the bilious
fever, and  he recovered  in a few days.   On the 15th day
of the same mondi I was sent for to visit his brother Wil-
liam, who  was seized with all the symptoms of the  same
disease.  Oh the 5th day his head-ach became extremely
acute,  and his pulse fell  to sixty strokes in a minute.  I
suspected congestion to have taken place in his brain, and
ordered him to lose  eightpunces of blood.   His pulse be-
came more frequent, and less tense after bleeding, and he
recovered a day or two afterwards.
   On  the 14th day of this month I was sent  for to visit
Mrs. Learning, the wife of Mr. Thomas Learning.  I sus-
pected at first that she had the influenza, but in a day or two
her fever put on bilious symptoms.  She was affected with
an uncommon disposition to  faint. Her pulse was languid,
but tense.  I  took  a few ounces of blood  from her, and
purged her with salts and calomel.  I afterwards gave her
a small dose of laudanum which disagreed with her.  In
my note book I find I have recorded that " she was worse
for it."  I was led to make this remark by its being so very
uncommon for a person,  who had been  properly bled and
purged, to take laudanum in a common bilious fever with-
out being benefited by it.   She recovered, however, slowly,
and was yellow for many  days afterwards.
  On the morning of the  18th of this month I was request-
ed to visit Peter Aston, in Vine-street, in consultation with
Dr. Say.   I found him on the third day of a  most acute
bilious fever.  His eyes were .inflamed, and his face flushed
with a  deep red colour.   His pulse seemed to forbid eva-
cuations.   We prescribed the strongest cordials, but to no
purpose.  We found him,  at  6 o'clock in the evening,
sitting upon the side of  his bed, perfectly  sensible,  but
without a pulse, with cold clammy hands, and his face of a
yellowish colour.  He died a few hours after we left him.
  None of the cases which I have mentioned excited the
least apprehension of the existence-of a malignant or yellow
fever in our city; for I had frequently seen sporadic cases
in which the common bilious fever of Philadelphia had put
on symptoms of great malignity, and terminated fatallv in
a few days, and now and  then with a yellow colour on the
skin, before or immediately after death.
   On the 19th of this month I was requested to visit the 
BILIOUS YELLOW FEVER OF 1793.
43
wife of Mr. Peter Le Maigre, in Water-street, between
Arch and Race-streets,  in consultation with Dr.  Foulkc
and Dr. Hodge.   I found her in the last stage  of a highly
bilious fever.  She vomited  constantly,  and complained
of great heat and burning in her stomach.  The most pow-
erful cordials and  tonics were prescribed, but to  no pur-
pose.  She died on the evening of the next day.
  Upon coming out of Mrs. Le Maigre's room I remark
ed to Dr. Foulke  and Dr. Hodge, that I had seen an un-
usual number of bilious fevers, accompanied with symp-
toms of uncommon malignity, and that I suspected all was
not right in our  city.  Dr. Hodge immediately  replied,
that a fever of a most malignant kind  had carried  off four
or five persons within  sight of Mr. Le Maigre's door, and
that one of them had  died in twelve hours after the attack
of the disease.   This information satisfied me that my ap-
prehensions were well founded.   The  origin of this fever
was  discovered to me at the same time, from the account
which Dr. Foulke gave me of a quantity of damaged coffee
which  had  been thrown upon Mr. Ball's wharf,  and in the
adjoining dock,- on the 24th of July,  nearly in  a line with
Mr. Le Maigre's house, and which had putrified there to
the great annoyance of the whole neighbourhood.
  After this consultation I was soon able to trace  all the
cases of fever which I have mentioned to this course.  Dr.
Hodge lived a few doors above Mr. Le Maigre's, where his
child had been exposed to the exhalation from  the coffee
for several days.   Mrs.  Bradford  had  spent an afternoon
in  a house directly opposite to the wharf and dock  on
which the putrid coffee had emitted its noxious  effluvia, a
few days before her sickness, and had been much  incom-
moded by it.  Her sister, Mrs. Learning, had  visited her
during her  illness at her  house, which  was about two hun-
dred yards from the  infected wharf.  Young Mr.  M'Nair
and  Mrs. Palmer's two sons  had spent whole days in a
compting house near  where the  coffee was exposed, and
each of them had complained of having been made sick by
its offensive smell,  and Mr. Aston had frequently been in
Water-street near the source of the exhalation.
  This discovery  of the malignity, extent, and origin of a
fever which I knew to be attended with great danger and
mortality, gave me great pain.   I did not hesitate to name 
44              AN ACCOUNT OF THE
 it the bilious remitting yellow fever.   I had once  seen it
 epidemic in Philadelphia, in the year 1762.  Its symptoms
 were among the  first impressions which diseases made
 upon my mind.  I had recorded some of these symptoms,
 as well as its mortality.   I shall  here introduce a short ac-
 count of  it, from a note book which I kept during my.ap-
 prenticeship.
   " In  the year 1762,  in the months of August, Septem-
 ber, October, November, and December, the bilious yel-
 low fever prevailed in Philadelphia, after a very hot summer,
 and spread like a plague, carrying off daily, for some time,
 upwards of twenty persons.
   " The patients were generally  seized with rigours, which
 were succeeded with a violent fever, and pains in the head
 and back.  The pulse was full, and sometimes  irregular.
 The eyes were inflamed,  and had  a yellowish  cast, and a
 vomiting  almost always attended.
   " The 3d, 5th, and  7th days  were  mostly critical, and
 the disease generally terminated  on one of them,  in  life  or
 death,
   " An eruption on the 3d or 7th day over the body prov-
 ed salutary.
   " An excessive heat and burning about the region of the
 liver, with cold extremities, portended death to be at hand."
  I  have  taken  notice, in my note book, of the principal
 remedy which was prescribed in this fever by my  preceptor
 in medicine, but this shall be mentioned hereafter.
  Upon my leaving Mrs. Le Maigre's, I expressed my
 distress at what I had discovered, to several of my fellow-
 citizens.  The report of a malignant and mortal  fever be-
 ing in town spread in every direction,  but it did not gain
 universal  credit.  Some of those physicians  who had not
 seen patients in it denied that any  such fever existed, and
 asserted (though its mortality was not denied)  that it was
 nothing but the common  annual  remittent of  the city
 Many of the citizens joined the physicians in endeavouring
to discredit, the account I had given of this fever, and for"
a while  it was treated with ridicule or contempt.   Indiona-
tion  in some instances was excited against me, and one  of
my friends, whom I advised in this early staee of the dis-
ease  to leave the city, has since told me that for that advice
  he had hated me," 
         BILIOUS  YELLOW FEVER OF  1793.       45

  My lot in having thus disturbed the repose of the public
mind, upon the subject of general health, was not a singu-
lar one.   There are many instances  upon record, of phy-
sicians who have rendered themselves unpopular, and even
odious to their fellow-citizens, by giving the first notice of
the existence of malignant  and mortal diseases.  A physi-
cian who asserted that the plague was in  Messina,  in  the
year. 1743, excited so much rage in  the minds of his fel-
low-citizens, against him, as to render it necessary for him
to save his life by retreating to one of the  churches of that
city.
  In  spite, however,  of all opposition,  the report of the
existence of a malignant fever in the city  gained so much
ground, that the governor of the state directed Dr. Hut-
chinson, the inspector of sickly vessels, to inquire into the
truth of it, and  into the nature of the disease.
  In consequence of this order, the  doctor wrote letters to
several of the physicians in the city, requesting information
relative to the fever.  To  his letter  to me, dated the 24th
of August, I replied on  the same day, and mentioned not
only the existence of a malignant fever,  but the streets it
occupied, and my belief of its being derived from a quan-
tity of coffee which had  putrified on a wharf near Arch-
street.  This,  and other information collected by the doc-
tor, was communicated  to the health officer, in  a letter
dated the 27th  of August, in which  he mentioned the parts
of  the city where the disease prevailed, and the number of
persons who had died of it,  supposed by him to be about
40, but  which  subsequent inquiries proved  to be more
than 150.  He mentioned  further, in addition to the da-
maged coffee, some putrid hides, and  other putrid animal
and vegetable  substances, as the supposed cause of the
fever, and  concluded by saying, as he had not  heard of any
foreigners or sailors being  infected, nor of its being found
in any lodging-houses, that " it was not  an imported dis-
ease."
   In the mean while the disease continued to spread, and
with a degree of mortality  that had never been known from
common fevers.
   On the 25th of the month, the college  of physicians was
summoned by  their president to meet, in order to  consult
about the  best  methods of checking the progress of the 
46
AN ACCOUNT  OF THE
fever  in the city.   After some  consideration upon  the
nature of the disease, a committee was appointed to draw
up some directions  for those purposes;  and the ne-:t day
the following were presented to the college, and adopted
unanimously by them.  They were afterwards published
in most of the newspapers.
                     Philadelphia, August 26th, 1793.
   The college of physicians having taken into considera-
tion the malignant and contagious fever that now  prevails
in this city, have agreed to recommend to  their fellow-
cjtizens the following means of preventing its progress.
   1st. That all unnecessary intercourse should be avoided
with such persons as are infected by it.
   2d. To place a mark upon the door or window of such
houses as have any infected persons in it.
   3d. To place the persons infected in the centre of large
and airy rooms,  in beds without curtains, and to pay the
strictest regard to cleanliness, by frequently changing their
body and bed linen, also by removing, as speedily as pos-
sible, all offensive matters from their rooms.
   4th.  To provide a large  and airy hospital, in the neigh-
bourhood  of the  city, for the reception of such poor  per-
sons  as cannot be accommodated with the above advantages
 in private houses.
   5th.  To put a stop to the tolling of the bells.
   6th.  To bury such persons as die of this fever in  car-
 riages, and in as private a manner as possible.
   7th.  To keep the streets and wharves  of the city  as
 clean as possible.  As the contagion of the disease may be
 taken into the  body, and pass out of it without producing
 the fever,  unless it be rendered active by some occasional
 cause, the following means should be attended to, to pre-
 vent the contagion being excited into action in the body.
   8th. To avoid all fatigue of body and mind.
   9th. To avoid standing  or  sitting in the sun; also in a
 current of air, or in the evening air.
    10th. To accommodate  the dress to the weather, and to
 exceed rather in warm, than in cool clothing.
    11th. To avoid intemperance, but to  use fermented
 liquors, such as wine, beer, and cyder, in moderation.
    The college conceive fires to be very ineffectual, if not 
         BILIOUS  YELLOW FEVER  OF 1793.        47

dangerous means of checking the progress  of this fever.
They have reason  to place more dependence  upon  the
burning of gunpowder.  The benefits of vinegar and cam*
phor are confined chiefly to infected rooms, and they cannot
be used too frequently upon handkerchiefs, or in smelling-
bottles,  by persons whose duty calls  to visit or attend the
sick.

      Signed by order of the college,
                       WILLIAM SHIPPEN, jun.
                                     Vice president.
                       SAMUEL P.  GRIFFITTS,
                                     Secretary.

   From a  conviction that the disease  originated in the
putrid exhalations from the damaged coffee, I published in
the American Daily  Advertiser, of  August 29th, a short
address to the citizens of Philadelphia, with a view of di-
recting the public attention to the spot where the coffee lay,
and thereby of checking the progress of the  fever as far as
it was continued by the original cause.
   This address had no  other effect than to produce fresh
clamours against the  author; for the citizens, as well as
most of the physicians of  Philadelphia, had adopted a tra-
ditional opinion that the yellow fever could exist among us
only by importation from the West-Indies.
   In consequence,  however, of a letter, from Dr. Foulke
to the mayor of the city,  in which  he had decided,  in a
positive manner, in favour of  the  generation of the fever
from the putrid coffee, the mayor gave orders for the remo-
val of the coffee, and  the  cleaning of the wharf and dock.
It was said that measures  were taken for this purpose;  but
Dr. Foulke, who visited the place where the coffee  lay,
repeatedly assured  me,  that they were so far  from being
effectual, that an offensive smell was exhaled from it many
days afterwards.
   I shall pass over, for the present, the facts and argu-
ments on which I ground my assertion of the generation
of this fever in our city.   They will come in more pro-
perly in die close of the history of the  disease.
   The  seeds of the fever, when received into the body,
were generally excited into action in  a few  days.  I met 
48              AN ACCOUNT OF  THE

with several cases in which they acted so as to produce a
fever on the same day in which they were received into the
system, and I heard of two cases in which they excited
sickness, fainting, and  fever widiin one hour after the per-
sons were  exposed to  them.   I met with no instance in
which there was a longer interval than sixteen days between
their being received into the body and the  production of
the disease.
  This poison acted differently in different  constitutions.,
according to previous habits,  to the  degrees of predispos-
ing debility, or to the quantity and concentration of the
miasmata which had  been received into the body.
  In some constitutions, the miasmata were at once a re-
mote, a predisposing, and an exciting cause  of the disease;
hence some persons were affected by them,  who  had  not
departed in any  instance from their ordinary habits of  liv-
ing, as to diet, dress, and exercise.  But  it  was more fre-
quently brought on by  those causes acting in succession to
each other.
  I shall here refer  the reader to  the principles laid down
in the outlines of the phenomena of fever, for an account?
of the manner in which the system was predisposed to this
disease, by the debility induced by the reduction of its ex-
citement, by action  and abstraction, and by subsequent
depression.  Where a predisposition was thus produced,
the fever was excited by the following causes, acting  di-
rectly or indirectly upon the system.   Wliere this  predis-
position did not exist, the exciting causes produced both
the predisposition and the disease.   They  wTere,
  1. Great labour, or exercise of body or mind, in walk-
ing, riding, watching,  or the  like.  It was labour which
excited the disease so universally among the  lower class of
people.   A long  walk often  induced it.  Few escaped it
after a day, or even a few hours spent in gunning.  A hard
trotting horse brought it upon two of my patients. Perhaps
riding on horseback,  and in the sun, was the exciting cause
of the disease in most  of the  citizens  and  strangers who
were affected by it  in their flight from  the city.   A fall
excited it in a girl, and a stroke  upon the head excited it
in a young man who came under my care.   Many people
were seized with the disease in consequence of their  ex-
ertions on the night of the 7th  of  September, in extin- 
BILIOUS YELLOW FEVER OF  1793.
49
guishing the fire which consumed Mr. Dobson's printing-
office, and even the less violent exercise of working the
fire engines,  for the  purpose of laying  the dust in the
streets, added frequently to the number of the sick.
  2. Heat, from every cause, but more especially the heat
of the sun, was a very common  exciting cause of the dis-
ease.   The register of the weather during the latter end of
August, the whole of September, and the first two weeks
in October, will show how much the heat of the sun must
have  contributed  to excite the disease, more especially
among labouring people.  The heat of common fires like-
wise became a frequent cause of the activity of the miasma-
ta, where they had been received into  the body ; hence the
greater mortality of the disease among bakers, blacksmiths,
and hatters than among any other class of people.
  3.  Intemperance  in  eating or  drinking.   A  plentiful
meal, and a few extra glasses of wine seldom failed of ex-
citing the fever.   But where the body was strongly im-
pregnated with the seeds of the disease,  even the smallest
deviation from the customary stimulus of diet, in respect
to quality or quantity, roused them into action.  A supper
of twelve oysters in one, and of but three in another, of my
patients, produced the disease.  Half an ounce of meat ex-
cited it  in a lady who had lived, by my advice, for two
weeks upon milk and vegetables, and  even a supper of sal-
lad,  dressed after the French fashion, excited it in one of
Dr. Mease's patients.
  4.  Fear.  In many people the disease was excited by a
sudden paroxysm of fear ;  but I saw  some remarkable  in-
stances  where timid people escaped the disease,  although
they were constantly exposed to it.   Perhaps a moderate
degree of fear served to counteract the excessive stimulus
of the miasmata, and thereby to preserve the body  in a state
of healthy equilibrium.  I am certain that fear did no harm
after the disease was formed, in" those cases where  great
morbid  excess of action had taken place.   It was an  early
discovery of this fact which led me not to conceal from my
patients the true name of this fever, when I was called to them  ,
on the day of their being attacked  by it. The fear co-operat- •  •=
ed with some  of my remedies (to be  mentioned hereafter)
in reducing the morbid excitement of the arterial system.
  5.  Grief.   It was remarkable that the disease  was not
VOL. IIT.
r. 
50              AN ACCOUNT OF  THE
excited in  many cases  in the  attendants upon the sick,
while there was a hope of their recover}'.  The grief which
followed the extinction of  hope, by death, frequently pro-
duced  it within  a day or two afterwards, and that  not in
one person  only, but often in most of the near relations of
the deceased.   But the disease was also produced by  a
change  in the state of the mind directly opposite to that
which  has  been mentioned.   Many persons that attended
patients who recovered,  were seized with the disease a day
or two after they were relieved  from the toils and anxiety
of nursing.   The collapse of the mind from the abstraction
of the  stimulus of hope and desire,  by their ample gratifi-
cation,  probably produced that debility, and loss of the
equilibrium in the system, which favoured the  activity of
the miasmata in the manner formerly mentioned.*
   The effects of both the states of mind which have been
described,  have  been happily  illustrated by two facts which
are recorded by Dr. Jackson.t  He tells us,  that the garri-
sons of Savannah and York-town were both healthy during
the siege of those towns, but that die former became sickly
as soon :   >e French and American armies  retreated from
before  it, and the latter,  immediately after its capitulation.
   6, Cold.  Its action, in exciting the disease, depended upon
the diminution of the necessary and natural heat of the body,
and thereby so far destroying the equilibrium of the system,
as to enable the  miasmata to produce excessive or convul-
sive motions in the blood-vessels.   The night air, even in
the warm month of September, was often so cool as to excite
the disease, where the dress and bed-clothes Were not ac-
commodated to it.  It was excited in one case by a person's
only wetting his feet, in the month of October, and ne-
glecting afterwards to  change  his  shoes  and  stockings.
Every change in the weather, that was less than that which
produces frost, evidently increased the number of sick peo-
ple.  This was obvious after the 18th and 19th of Septem-
ber, when the mercury fell to 44° and 45°.   The hopes of
the city received a severe disappointment upon this occa-
sion, for I well  recollect  there  was a general expectation
that this change in the weather would have checked the
disease.  The  same increase of the number of sick was
* Outlines of the phenomena of fever.
f Treatise on the Fevers of Jamaica, p. 298. 
BILIOUS YELLOW FEVER OF 1793.
51
observed to follow the cool weather which succeeded the
6th and 7th of October, on which days the mercury fell to
43° and 46°.
   It was observed that those persons who were habitually
exposed to the cool air, were less liable to the disease than
others.  I ascribe it to the habitual impression of the cool
night air upon  the bodies of the city watchmen, that  but
four or five of them, out of twenty-five, were affected by
the disease.
   After the body had been  heated  by violent exercise, a
breeze of cool air sometimes  excited the disease in those
cases where there had  been no change in the temperature
of the weather.
   7.  Sleep.  A great  proportion of all who were affected
by this  fever,  were attacked  in the night.   Sleep induced
what I  have called debility from abstraction, and thereby
disposed the miasmata which floated in the blood, to act
with such force upon the system as to destroy its equilibri-
um, and thus to excite a fever.  The influence of sleep, as
a predisposing  and exciting  cause,  was often assisted by
the want of bed-clothes, suited to the midnight or morning
coolness of the air.
   8.  Immoderate evacuations.  The efficacy of moderate
purging and bleeding in preventing the disease, led some
people to use those remedies in an excess, which both pre-
disposed to the disease, and excited it.  The morbid effects
of these evacuations, were much aided  by fear, for it was
this passion which perverted  the judgment in such a man-
ner,  as  to lead  to the excessive use of remedies, which to
be effectual, should only be used in moderate quantities.
   The disease  appeared with different symptoms, and in
different degrees, in different people.   They both varied
likewise with the weather.   In  describing  the  disease,  I
shall take notice of the changes  in  the symptoms, which
were produced by changes in the temperature of the air.
   The precursors, or premonitory signs of this fever were,
costiveness, a dull pain in the right side, defect of appetite,
flatulency,  perverted taste,  heatin the stomach,  giddiness,
or pain in the head, a dull, watery, brilliant, yellow, or red
eye, dim and imperfect vision, a hoarseness, or slight sore
throat, low spirits,  or  unusual vivacity, a moisture on the
hands, a disposition to sweat at nights,  or after  moderate. 
52
AN ACCOUNT OF THE
 exercise,  or a sudden suppression of night sweats.  The
 dull eye and the lowness of spirits, appeared to be the ef-
 fects of such an excess in the stimulus of the miasmata as
 to induce depression, while the brilliant eye, and the unu-
 sual vivacity, seemed to have been produced by a less quan-
 tity  of the miasmata acting as a cordial  upon the  system.
 More  or less of these symptoms, frequently continued for
 two  or three days before the patients were confined to their
 beds, and in some people they continued during the whole
 time of its prevalence in the city, without producing  the
 disease.   I wish these symptoms to be remembered by the
 reader. They will form the corner stone of a system which
 I hope will either eradicate  the disease altogether, or render
 it as safe as an intermitting fever, or as the small-pox when
 it is  received by inoculation.
  Frequent as these precursors of the fever were, they were
 not  universal.  Many went to bed  in  good health,  and
 awoke in the night with a chilly fit.  Many rose in the morn-
 ing after regular and natural sleep, and were seized at their
 work,  or after a walk, with a sudden and unexpected attack
 of the fever.  In most of these cases the disease came on
 with a chilly fit,  which afforded by its violence or duration
 a tolerable presage of the issue of the disease.
  Upon entering a.sick room where a patient was confined
 by this fever, the first thing that struck the eye of a physi-
 cian  was the countenance.   It  was as much unlike that
 which is exhibited in the common bilious fever, as the face
 of a  wild, is unlike the face of a mild domestic animal.
 The eyes were  sad, watery,  and  so inflamed, in some
 cases,  as to resemble two  balls of fire.   Sometimes they
 had a  most brilliant or ferocious appearance.   The face
 was  suffused  with blood,  or of a  dusky  colour, and the
 whole countenance was downcast and clouded.   After the
 10th of September, when a determination of blood  to the
 brain became universal, there was a preternatural dilatation
 ot the pupil.  Sighing attended in almost everv case   The
 skm  was dry, and frequently of its  natural "temperature.
 These were the principal symptoms which discovered them-
 selves to the eye and hand of a physician.   The answers^
the first questions proposed upon\isiting a patienT we e
calculated to produce a belief in the  mind oL  physichn
that the d.sease under which the patient laboured wa  not 
          BILIOUS YELLOW  FEVER  OF 1793.        53

the prevailing malignant  epidemic.  I  did not for many
weeks meet with a dozen  patients, who acknowledged that
they had any other indisposition tlian a common cold, or a
slight remitting  or  intermitting fever.   I was particularly
struck with this  self-deception in many persons, who had
nursed relations that had died with the yellow fever, and
who had been  exposed to it in neighbourhoods where it
had prevailed for days and even weeks with great mortality.
I shall hereafter  trace a part  of this disposition in the sick
to deceive themselves, to the influence of certain publica-
tions, which appeared soon after the disease became epide-
mic in the city.
   In the further history of this  fever,  I shall describe its
symptoms as they appeared—
   I.  In  the sanguiferous system.
   II. In the liver, lungs, and brain.
   III. In  the alimentary canal;  in  which  I include  the
stomach as well as the bowels.
   IV. In the secretions and excretions.
   V. In the nervous system.
   VI. In the senses and appetites.
   VII.  In the lymphatic and glandular system.
   VIII. Upon  the skin.
   IX. In the blood.
   After having finished  this detail, I shall mention some
general characters ,of the disease, and  afterwards subdivide
it into classes, according to its degrees and duration.
   I.  The blood-vessels were affected more or less in every
case  of this fever.   I have  elewhere  said, that  a fever is
occasioned by a convulsion in the arterial system.*  When
the epidemic, which we are now considering, came on with
<a full, tense,  and quick pulse, this convulsion was very
perceptible; but it frequently came on with a weak pulse,
often  without  any preternatural frequency  or  quickness,
and sometimes so low as not to be perceived without press-
ing the artery at the wrists. In many cases the pulse inter-
mitted after the  fourth, in some after the fifth, and in others
after the fourteenth  stroke.   These intermissions occurred
in several  persons who were  infected, but who were  not
confined by the fever.  They likewise continued in several
of my patients  for many days after their recovery.  This
               * Outlines of the phenomena of fever. 
54
AN ACCOUNT  OF THE
was the case in particular in Mrs.  Clymer, Mrs.  Palmer's
son William, and in a son of Mr.  William Compton.   In
some, there was a  preternatural slowness of the pulse.   It
beat 44 strokes in a minute in  Mr. B. W. Morris, 48 in
Mr.  Thomas  Warton, jun. and 64 in Mr. William San-
som, at a time when they were in the most imminent dan-
ger/  Dr. Physick informed  me  that in one of his pa-
tients the pulse was reduced in frequency to 30 strokes in
a minute.   All these different states of the pulse have been
taken notice of by authors who have described pestilential
fevers.*  They have  been improperly  ascribed to the ab-
sence of fever: I would  rather suppose that they are oc-
casioned by the stimulus of the remote cause acting upon
the arteries with too  much  force  to admit of their  being
excited into quick and convulsive motions.   The remedy
which removed it (to be mentioned hereafter)  will render
this explanation of its cause still more probable.  Milton
describes a darkness from  an excess  of light.   In like
manner we  observe, in  this small, intermitting, and  slow
pulse, a deficiency of strength from an excess of force ap-
plied to it.  In nearly every  case  of it which came under
my notice, it was likewise tense or chorded.   This species
of pulse occurred  chiefly in the month of August, and in
the first ten  days in  September.  I had met with it for-
merly in a sporadic case of  yellow fever.   It  was new to
all my  pupils.  One of them,  Mr. Washington, gave it
the name of the " undescribable pulse."  It aided in deter-
mining the character of  this fever  before the common bili-
ous remittent disappeared in the city.  For awhile, I ascri-
bed this peculiarity in the pulse, more especially its slow-
ness,  to an affection  of  the brain only, and suspected that
it was produced by what I have taken the liberty elsewhere
to call the phrenieula, or inflammatory  state of the internal
dropsy of the brain, and which  I  have remarked to be an
occasional symptom and consequence of remitting fever, f
I was the more disposed to  adopt this opinion, from -per-
ceiving this slow,  chorded,  and intermitting  pulse  more
frequently in children than in adults.   Impressed with this
idea, I requested Mr. Coxe, one of my pupils, to assist me
  * Vergasca,  Sorbait, and Boate in Haller's Bibliotheca Medicinse, vol. iii,
also by Dr. Stubbs in the Philosophical  Transactions, and Riverius in his
'.Treatise de Febre  Pestilenti.
  + Yt>!. ii. 
BILIOUS YELLOW  FEVER  OF 1793.        55
 in examining the state of the eyes. For two days we disco-
 vered no change in them, but  on the third day after we
 began to inspect them, we both perceived a preternatural
 dilatation of the pupils, in different patients; and we seldom
 afterwards saw an eye in which  it was absent.  In Dr. Say
 it was attended by a squinting,  a symptom which marks
 a high degree of a morbid affection of the brain.  Had this
 slowness or intermission in the pulse occurred only after
 signs of inflammation or congestion had appeared in the
 brain, I should  have supposed  that  it had been derived
 wholly from that cause;  but I well recollect having felt it
 several days before I could discover the least change in the
 pupil of the  eye.  I am  forced therefore to call in the
 operation of another cause, to assist in accounting for this
 state of the pulse, and this I take to be a spasmodic affec-
 tion accompanied with preternatural  dilatation or contrac-
 tion of the heart.  Lieutaud mentions this species of pulse
 in several places, as occurring with an undue enlargement
 of that muscle.* Dr. Ferriar  describes a case, in  which a
 low, irregular, intermitting, and hardly  perceptible pulse
 attended a  morbid dilatation of the heart, f  In a letter I re
 ceived from Mr. Hugh Furguson, then a student  of medi-
 cine in the college of Edinburgh, written from Dublin,
 during the time of a visit to his father, and dated Septem-
 ber 30th, 1793, I find a fact which throws additional light
 upon this subject.   " A case (says my young correspon-
 dent) where a remarkable intermission of pulse was observ-
 ed, occurred in this city  last year.   A gentleman of the
 medical profession, middle aged, of a delicate habit of body,
and who had formerly suffered phthisical attacks, was attacked
 with the acute rheumatism.  Some days after he was taken
 ill, he complained of uncommon fulness, and a very peculiar
 kind of sensation about the prsecordia, which it was judged
 proper to relieve  by copious blood-letting.   This being
 done, the uneasiness went off.    It returned, however, three
 or four times, and was as often relieved by bleeding. Dur-
 ing each of his fits (if I may call them so), the patient ex-
 perienced an almost total  remission of his pains in his
 limbs; but they returned with  equal or greater  violence
after blood-letting.   During the  fit there was an  intermis-

 * Historia Anatomica  Medica, vol. ii. obs. 40$, 418, 423, 510.
 f Medical Histories and Reflections, p. 150 
56
AN  ACCOUNT OF THE
sion of the pulse (the first time) of no less than thirteen
strokes.   It was when beating full, strong, and slow. The
third intermission was  of nine strokes.   The  gentleman
soon recovered, and has enjoyed good health for ten months
past.  The  opinion of some of his physicians  was,  that
the heart was affected, as a muscle, by the rheumatism, and
alternated with the limbs."
   I am the  more inclined to believe the peculiarity in the
pulse, which has been mentioned in the yellow fever, arose
in part from a spasmodic affection of the heart, from the
frequency of an uncommon  palpitation  of this muscle,
which I discovered in this disease, more  especially  in old
people.   The disposition, likewise, to syncope and sighing,
which so often occurred,  can be explained upon no other
principle than inflammation, spasm, dilatation,  or conges-
tion in the heart.  After the 10th of September this unde-
scribable or sulky pulse (for by the latter epithet I some-
times called it) became less observable, and in proportion
as the weather became  cool, it totally disappeared.   It was
gradually succeeded by  a pulse  full, tense, quick, and as
frequent as in pleurisy or rheumatism.   It differed, how-
ever, from a pleuritic or rheumatic pulse,  in imparting a
very different sensation to the fingers.  No two strokes
seemed to be exactly alike.   Its action was of a hobbling
nature.   It was at this  time so familiar to me  that I think
I could have distinguished the disease by it without seeing
the patient.   It  was remarkable  that this pulse attended
the yellow fever even when it  appeared in the mild form  of
an intermittent, and in those cases where the patients were
able to walk about or go abroad.  It was  nearly as tense
in the remissions and intermissions of  the  fever as it was
in the  exacerbations.  It was an alarming  symptom, and
when the only remedy which was effectual to remove it
was neglected, such a  change in  the system was induced
as frequently brought on death in a fewdays.
   This change of the pulse, from extreme lowness to ful-
ness and activity, appeared to  be  owing to the diminution
of the heat of the weather, which by its stimulus, added
to that of the remote cause, had  induced those symptoms
of depression of the pulse which have been mentioned.
   The pulse most  frequently lessened in its fulness, and
became gradually weak, frequent, and imperceptible before 
BILIOUS YELLOW FEVER OF 1793.
57
death, but  I met  with several cases in which it was full,
active, and  even tense in the last hours of life.
  Hemorrhages belong to the symptoms of this fever  as
they appeared in  the sanguiferous system.  They occur-
red in the  beginning of the disease, chiefly from the nose
and uterus.  Sometimes but a few drops  of blood distil-
led from the nose.  The menses were unusual in their quan-
tity when they appeared at their stated periods, but they
often came on a week or two before the usual time of their
appearance.  I saw one case of an haemorrhage from the
lungs on the first day of the fever,  which was supposed to
be  a  common haemoptysis.  As the disease advanced the
discharges of blood became more universal.  They occur-
red from the  gums, ears,  stomach, bowels,  and urinary
passages.   Drops of blood issued  from the inner  canthus
of the left eye of Mr. Josiah Coates.   Dr.  Woodhouse at-
tended a lady  who bled from the holes in her ears which
had been made by ear-rings.  Many bled from the orifices
which had  been made by bleeding, several days after they
appeared to  have been healed,  and  some from  wounds
which had  been made in veins in unsuccessful attempts to
draw blood.   These last haemorrhages were very trouble-
some, and in some cases precipitated death.
   II. I come now to mention the symptoms of this fever
as they appeared in the liver, the lungs,  and  the brain.
From the histories which I  had read of this disease, I was
early  led to examine the state of the liver,  but I was  sur-
prised to find so few  marks of hepatic affection. I met with
but two cases in  which the patient could lie only on the
right side.  Many complained  of a dull pain in the region
of the liver, but very few complained in the beginning  of
the disease, of that soreness to the touch,  about the pit of
the stomach, which is taken  notice of by authors, and which
was universal in the yellow  fever in 1762.   In proportion
as the cool  weather advanced, a preternatural determination
of the blood  took place chiefly  to the lungs and brain.
Many were affected with pneumonic symptoms, and some
appeared to die of sudden effusions of blood or serum  in
the lungs.  It  was an unexpected effusion of this kind
which put an end to the life of Mrs. Kepple after she had
exhibited hopeful  signs of a recovery.
  I saw one person who recovered  from an affection of the
    VOL. III.              H 
58
AN ACCOUNT OF THE
 lungs, by means of a copious expectoration of yellow phlegm
 and mucus.  But the brain was principally  affected with
 morbid congestion in this disease.  It was indicated by the
 suffusion of blood in the face, by the redness of the eyes,
 by a dilatation of the pupils, by the pain in the head, by the
 haemorrhages from the nose and ears, by the sickness  or
 vomiting,  and by an almost universal costive state of the
 bowels.   I wish to impress the reader with these facts, for
 they formed one of the strongest indications for the use of
 the  remedies which I adopted for the cure of this disease.
 It is difficult to determine the exact state of these viscera in
 every  case of bilious and yellow fever.  Inflammation cer-
 tainly takes place in some cases, and internal  haemorrhages
 in others;  but I believe the most frequent affection of these
 viscera consists in a certain morbid accumulation of blood in
 them, which has been happily called, by Dr. Clark, an en-
gorgement or chpaking of the blood-vessels.  I believe fur-
 ther, with Dr. Clark* and Dr. Balfour,f that death in most
 cases in bilious fevers is the effect of these morbid conges-
 tions, and wholly unconnected with an exhausted state of the
 system, or a supposed putrefaction in the fluids.  It is true,
 the  dissections  of Dr.  Physick and  Dr. Cathrall (to be
 mentioned hereafter)  discovered no morbid appearances in
 any  of the viscera which have been mentioned, but it should
be remembered,  that these  dissections were made early in
the disease.  Dr. Annan attended the dissection of a brain
 of a patient who died at Bush-hill some days afterwards, and
observed the blood-vessels to be unusually turgid. In those
 cases where congestion only takes place, it is as  easy  to
conceive that all morbid appearances in the brain may cease
after death, as that the suffusion of blood in the face should
disappear after the retreat of the blood from the extremities
of the vessels, in  the last moments of life.   It is no new
thing for  morbid  excitement of the  brain to leave either
slender, or no marks of disease after death.   This,  I have
said, is often the case where  it exceeds that degree of action
which produces an effusion of red blood into serous vessels,
or what  is  called inflammation.^  Dr. Quin has given  a
dissection of the brain  of a child  that died  with all the
symptoms of hydrocephalus internus,  and yet nothing was

  * Vol. i. p. 168.    f Treatise on the Intestinal Remitting Fever, p 125
  t Outlines of the phenomena of fever. 
BILIOUS YELLOW FEVER OF 1793.        59
discovered in the brain but a slight turgescence of its blood-
vessels.  Dr. Girdlestone says, no injury appeared in the
brains of those persons who died of the symptomatic apo-
plexy,  which occurred in a spasmodic disease, which he
describes, in the East-Indies; and Mr. Clark informs us,
that the brain was in a natural state in every case of death
from puerperile fever, notwithstanding it seemed to be af-
fected in many cases soon after the attack of that disease.*
  I wish it to be remembered here, that the yellow fever,
like all other diseases, is influenced by climate and  seasons.
The determination of the fluids is seldom the same in dif-
ferent years, and I am sure it varied with the weather in the
disease which  I am now describing.   Dr. Jackson speaks
of the head being most affected in the West-India fevers in
dry situations.   Dr. Hillary says, that there was an unusu-
al determination of  the blood towards the brain, after a hot
and dry season, in the fevers of Barbadoes in the year 1753;
and Dr. Ferriar, in his account of an epidemic jail  fever in
Manchester, in 1789,  1790, informs us,  that as  soon as
frost set in, a delirium became a more frequent symptom.
of that disease, than it had been in more temperate weather.
   III. The stomach and bowels were affected  in many ways
in this fever.   The disease seldom appeared without nau-
sea or vomiting.   In some cases they both occurred far
several days or a week  before they were accompanied by
any fever.   Sometimes a pain, known by the name of gas-
trodynia,  ushered in the  disease.  The stomach  was  so
extremely irritable as to reject drinks of every kind. Some-
times green or yellow bile was ejected on the first day of
the disease by vomiting;  but  I much oftener saw  it conti-
nue for two days without discharging any thing from the
stomach, but the drinks which were taken by the patient.
If the fever in any case came on  without vomiting, or if it
had been checked by remedies tliat were ineffectual  to re-
move it  altogether,  it generally appeared, or returned, on
the 4th or 5th day of the disease.   I dreaded this symptom
on those days, for  although it was not always the fore-
runner of death, yet it generally rendered  the recovery
more difficult  and tedious.  In  some oases the vomiting
was  more or less constant from the beginning to  the end
of the disease,  whether it terminated in life or death.
  • Essay on the Tpidemir Diseases of T-ving>-in Women, of the vent* 1787 and
1788, p. 34 
60
AN  ACCOUNT OF THE
   The vomiting which  came on about the 4th or 5th day,
was accompanied with a burning pain in the region of  the
stomach.   It produced  great anxiety,  and tossing of  the
body from one part of the bed to another.  In some cases,
this painful burning occurred before any vomiting had ta-
ken place.   Drinks were now rejected from the stomach so
suddenly* as often to be discharged over the hand that lifted
them to the head  of the patient.  The contents of the sto-
mach  (to be mentioned hereafter) were sometimes thrown
up with a convulsive motion,  that  propelled them in a
stream to a great distance, and in some  cases all over the
clothes of the by-standers.
   Flatulency was  an  almost universal  symptom, in every
stage of this disease.  It was very distressing in many cases.
It occurred chiefly in the stomach.
   The bowels were generally costive, and in some patients
as obstinately so as in the dry gripes.   In some cases there
was all the  pain and distress of a bilious  colic, and in others,
the tenesmus,  and mucous and bloody discharges of a true
dysentery.   A diarrhoea  introduced  the  disease  in a few
persons, but it was chiefly in those who had been previous-
ly indisposed with weak bowels.  A painful tension of the
abdomen took place in many, accompanied in some instan-
ces by a dull,  and in others by  an acute pain  in the lower
part of the belly.
   IV. I come now to describe the state of the secretions and
excretions  as they appeared in different stages of this fever.
   In some cases there was a constipation of the  liver, if I
may be allowed that expression, or a total obstruction of se-
cretion and excretion of bile, but more  frequently a preter-
natural secretion and excretion of it took place. It was dis-
charged, in most cases, from the stomach and bowels in large
quantities, and of very different  qualities and colours.
   1. On die first and  second days of the disease many  pa-
tients puked from half a pint to  nearly a quart  of green  or
yellow bile.  Four cases came under my notice in which
black bile was discharged on the first day.  Three of these
patients recovered.
   2. There was frequently, on the 4th or 5th day, a dis-
charge of matter from the stomach,  resembling coffee im-
pregnated with its grounds.  This was always  an alarming
symptom.  I believed it at first to be a modification of vi- 
         BILIOUS YELLOW  FEVER OF 1793.       61

tiated bile, but subsequent dissections by Dr. Physick have
taught me that it was the result of the first stage of those
morbid actions in the stomach, which afterwards produce
the black vomit.  Many recovered who discharged this cof-
fee-coloured matter.
  3. Towards the  close of this disease, there was a dis-
charge of matter of a deep or pale black colour, from the
stomach. Flaky  substances frequently floated in  the basin
or chamber-pot  upon the surface  of this  matter.  It was
what is called the black-vomit.  It was formerly  supposed
to be  vitiated bile, but it has been proved by Dr. Stewart,
and afterwards by Dr. Physick, to be the effect of disease
in the stomach.
  4.  There was frequently discharged from the stomach in
the close of the disease, a large quantity of grumous blood,
which exhibited a  dark colour on its outside, resembling
that of some of the matters which have been described, and
which I believe was frequently mistaken for what is  com-
monly known by the name of the black vomit.  Several of
my patients did me the  honour to say, I  had cured them
after that symptom of approaching dissolution had made its
appearance; but I am  inclined to believe, dark-coloured
blood, only, or  the  coffee-coloured  matter, was mistaken
for the  matters  which constitute the fatal black  vomiting.
I except here the black discharge before mentioned, ..which
took place in three cases on the first day of the disease.  This
I have no doubt was bile, but it had not acquired its greatest
acrimony, and  it was discharged  before mortification, or
even inflammation  could have taken place in the stomach.
Several persons died without a black vomiting of any kind.
   Along with all the discharges  from the  stomach which
have been described, there was occasionally a large worm,
and frequently large quantities of mucous and tough phlegm.
   The colour, quality, and quantity of the faces depended
very much upon the treatment of the disease.   Where ac-
tive purges had been given, the stools were copious, foetid,
and of  a black  or dark colour.  When they were sponta-
neous, or excited by weak purges, they had a more  natu-
ral appearance.   In both cases they  were sometimes of a
green, and sometimes of an olive colour. Their smell was
more or less foetid, according to the time in which they had
been detained in the bowels. I visited a lady who had pass- 
62
AN ACCOUNT  OF THE7
ed several days without a stool, and who had been treated
with tonic remedies.  I gave  her a purge, which in a few
hours procured a discharge of faeces, so extremely foetid,
that they produced fainting in an old woman who attended
her.  The acrimony of the faeces was such as to excoriate
the rectum, and sometimes to produce an extensive inflam-
mation all around its external termination.  The quantity
of stools produced by  a single purge was in many cases
very great.   They could be accounted  for only by calling
in the constant and  rapid formation of them, by preterna-
tural effusions of bile into the bowels.
   I attended one person, and heard of two others, in whom
the stools were  as white as in  the jaundice.  I suspected,
in these cases, the  liver to be so constipated or paralyzed
by the disease, as to be unable to secrete or excrete bile to
colour the  faeces.   Large  round worms  were  frequently
discharged  with the stools.
   The urine was in some cases  plentiful, and  of a  high
colour.   It was at  times clear, and at other times turbid.
About the 4th or 5th day, it  sometimes assumed a  dark
colour, and resembled strong  coffee.   This colour,  con-
tinued, in one instance, for several days  after the patient
recovered.  In  some, the discharge was accompanied by a
burning pain, resembling that  which  takes place in a  go-
norrhoea.  I met with one case in which this burning came
on only in the evening,  with the exacerbation of the fever,
and went off with its remission in the morning.
  A total deficiency of the urine took place in many peo-
ple for a day or two, without pain.  Dr. Sydenham  takes
notice of the  same  symptom  in die  highly inflammatory
small-pox.* It generally accompanied or portended great
danger.  I heard of one case in  which there was a suppres-
sion of urine, which could not be relieved without the use
of the catheter.
   A young man was attended by Mr. Fisher, one of my
pupils, who discharged several quarts of limpid urine just
before he died.
   Dr. Arthaud  informs us, in  the history of a  dissection
of a person who died of the yellow fever, that  the urine
after death imparted a green colour to the tincture of ra-
dishes, f
  * Wallace's edition, vol. i. p. 197.
  f Hosier's Journal for January, 1790. vol. xxxvi. p. 38(>. 
BILIOUS
YELLOW FEVER OF  1793.
6.3
  Many  people  were relieved by copious sweats on  the
first day  of the disease.   They  were in some instances
spontaneous,  and in others they were exited by diluting
drinks, or by strong purges.   These sweats were often of
a yellow colour, and  sometimes had an offensive smell.
They were in some cases  cold, and attended at the same
time with a full  pulse.  In general, the skin was  dry in
the beginning, as well as in the subsequent  stages of the
disease.   I saw but few instances  of its terminating like
common fevers, by sweat, after the third day.  I wish this
fact to be remembered by the reader, for it laid part of the
foundation of my method of treating this fever.
   There was in  some cases a preternatural  secretion  and
excretion of mucus from the glands of the throat.   It  was
discharged by an  almost constant  hawking  and spitting.
All who had this symptom recovered.
   The tongue was in every  case moist, and of a white
colour, on the first and second days of the fever.   As the
disease advanced,  it assumed a red colour, and a smooth
shining  appearance.   It was not  quite  dry in this state.
Towards the close of the fever, a dry black  streak appear-
ed in its middle, which gradually extended to every part of
it.  Few recovered after this appearance on the tongue took
place.
   V.  In the nervous system  the  symptoms of the fevei
were different, according as it affected the brain, the mus-
cles,  fhe nerves, or the mind.  The sudden  and violen:
action of the miasmata induced apoplexy in several people.
In some, it brought on syncope,  and in others, convulsions
in every part of the body.  The apoplectic cases generallv
proved fatal, for they fell chiefly upon hard drinkers.  Per-
sons affected  by syncope,  or  convulsions, sometimes fell
down in  the  streets.  Two  cases  of this kind happened
near my house.  One of them came under my notice. He
was  supposed by the by-standers  to be drunk, but his
countenance and convulsive motions soon convinced me
that this  was not the case.
   A coma was observed in some  people, or an obstinate
wakefulness in every stage of  the  disease.  The latter
symptom most  frequently  attended the convalescence.
Many were affected with immobility, or  numbness in their
limbs. 
64
AN  ACCOUNT  OF THE
   These symptoms were constant, or temporary, according
to the nature of the remedies which were made use of to
remove them.  They extended to all  the limbs, in some
cases, and only to a part of them in others.  In  some, a
violent cramp, both in the arms and legs, attended the first
attack of the fever.  I met with  one  case in which there
was a difficulty of swallowing, from a spasmodic affection
of the throat, such as occurs in the locked jaw.
   A hiccup attended  the last stage  of this disease, but I
think less frequently  than the last stage of the common
bilious fever.  I saw but five cases of recovery where this
symptom took place.
   There was, in some instances, a deficiency of sensibility,
but in  others, a degree of it extending' to every part of the
body, which rendered the application  of common rum to
the skin, and even the least motion of the limbs, painful.
   I was surprised to observe the last stage of this fever to
exhibit  so few of the symptoms of the common typhus or
chronic fever. Tremors of the limbs and twitchings of the
tendons were uncommon.   They occurred only in those
cases in which there was a predisposition to nervous dis-
eases, and chiefly in the convalescent state of the disease.
  While the muscles  and nerves  in many cases exhibited
so many marks  of preternatural weakness, in some they
appeared to  be affected with  preternatural excitement.
Hence  patients in the close of the disease often rose from
their beds, walked across their rooms, or came down stairs,
with as much ease as if they had been in perfect health.   I
lost a patient in whom this state of morbid strength occur-
red to such a degree, that he stood up before his. glass and
shaved himself,  on the day upon which he died.
   The mind suffered with the morbid  states  of the brain
and nerves.   A delirium  was a  common  symptom.  It
alternated in some cases with the exacerbations and remis-
sions of the  fever.  In some it continued without a remis-
sion, until  a few  hours before death.  Many,  however,
passed through the whole course of the disease without
the least derangement in their ideas, even where there were
evident signs of morbid congestion in the brain.   Some
were seized with maniacal symptoms.   In these there was
an apparent absence of fever.   Such was the degree of this
mania in one man, that he stripped off his shirt, left his bed, 
         BILIOUS  YELLOW FEVER  OF 1793*.       65

and ran through the streets, with no other covering than a
napkin on his head, at 8 o'clock at night, to the great terror
of all who met him.  The symptoms of mania  occurred
most frequently towards the close of the disease, and some-
times continued for many days and weeks, after all other
febrile symptoms had disappeared.
  The temper was much affected  in this fever.  There
were few in whom it did not produce great depression of
spirits.  This  was the case in many, in whom pious habits
had subdued the  fear of death.  In some the temper be-
came very irritable.  Two cases of this kind came under
my notice, in  persons who, in good  health, were distin-
guished for uncommon sweetness of disposition and man-
ners.
  I observed in several persons the operations of the under-
standing  to be unimpaired throughout the  whole course
of the fever, who retained no  remembrance of any  thing
that passed in their sickness.  My pupil,  Mr. Fisher, fur-
nished a remarkable example of this correctness of under-
Standing, with a suspension of memory.   He neither said
nor did any thing, during his illness, that  indicated the
least derangement of mind, and yet he recollected nothing
that passed in his  room, except my  visits to him.   His
memory awakened  upon my taking him by the hand, on
the morning of the 6th day of his disease, and congratulat-
ing him upon  his escape from the grave.
  In some, there was a weakness, or total defect of memory,
for  several weeks after their recovery.  Dr.  Woodliouse
informed me that  he had met with a woman, who,  after
she had recovered, could not recollect her own name.
  Perhaps it would be proper  to rank that self-deception
with respect to the nature and danger of the disease, which
was so universal, among the instances of derangement of
mind.
  The pain which attended the disease was  different,  ac-
cording to the different  states  of the system.  In those
cases in which it sunk  under the violence  of the disease,
there  was little or no  pain.   In proportion as the system
was relieved from this oppression it recovered its sensibility.
The pain in the head was acute and distressing.   It affect-
ed the eye-balls in a peculiar manner.  A  pain extended,
in some cases, from the back of the head down the neck»
  VOL. Ill                I 
66
AN ACCOUNT  OF THE
The ears were affected, in several persons, with a painful
sensation, which they  compared to a string drawing thei*
two ears together through the brain.   The sides, and the
regions of the stomach, liver and bowels, were all, in dif-
ferent people, the seats of either dull or acute pains.  The
stomach, towards the close of the disease, was affected with
a burning or spasmodic pain of the most distressing nature.
It produced in some cases, great anguish of body and mind.
In others it  produced cries and shrieks, which were often
heard on the opposite side of the streets to where the patients
lay.   The back suffered very much  in this disease.  The
stoutest men complained, and even groaned under it.  An
acute pain extended, in some cases, from the back to one,
or both thighs. The arms and legs sympathized with every
other part of the body.  One of my patients,  upon whose
limbs the disease fell with its principal force,  said that his
legs felt as if they had  been scraped with a sharp instru-
ment.   The sympathy of friends with the distresses of the
sick extended to a small part of their misery, when it did
not include their sufferings  from pain.  One of the dearest
friends I ever lost  by death declared, in the  height of her
illness, that  " no one knew  the pains  of a yellow fever, but
those who felt them."
  VI. The senses and appetites exhibited several marks of
the universal ravages of this fever upon  the body. A deaf-
ness attended in many  cases, but it was not often,  as in the
nervous fever, a favourable symptom.  A  dimness of sight
was very common in the beginning of the disease.  Many
were affected with temporary blindness.  In some there was
a loss of sight in consequence of gutta serena, or a total de-
struction of the substance of the eye.  There was in many
persons a soreness to the touch which extended all over the
body.   I have often observed this symptom to be the fore-
runner of a favourable issue of a nervous fever, but it was
less frequently the case in this disease.
   The thirst was  moderate or absent in some cases,  but it
occurred in the greatest number of persons whom I 'saw in
this fever.   Sometimes it was  very  intense.   One of mv
patients, who suffered by an  excessive  draught  of cold
water, declared,  just before he  died, that " he could drink
up the Delaware." It was always  an alarming symptom
when this thirst came  on in this extravagant  deerec in the 
BILIOUS YELLOW  FEVER  OF 1793.
67
 last stage of the  disease.   In the beginning of the fever it
 generally abated  upon  the appearance of a moist skin.
 Water was preferred to all other drinks.
   The appetite for food was impaired in this, as in all
 other fevers, but it returned much sooner than is common
 after the patient began to recover.   Coffee  was relished in
 the remissions of the fever, in every stage  of the disease.
 So keen was the appetite for solid, and more especially for
 animal food, after the solution of the fever, that many suf-
 fered from eating aliment that was improper from its quali-
 ty or quantity. There was a general disrelish for wine, but
 malt liquors were frequently grateful to the  taste.
   Many people retained a relish for  tobacco much  longer
 after they were attacked by this fever, and acquired a relish
 for it much sooner after they began to recover, than are com-
 mon in any other febrile disease. I met with one case in which
 a man, who was so ill as to require two bleedings, conti-
 nued to chew tobacco through every stage of his fever.
   The convalescence from this disease was marked, in some
 instances, by a sudden revival of  the venereal appetite.
 Several weddings took place in the city between persons
 who had  recovered  from the fever.   Twelve took place
 among the  convalescents in the  hospital at Bush-hill.   I
 wish I could add that the passion of the sexes for each other,
 among those subjects of public charity, was always gratifi-
 ed only in a lawful way.   Delicacy  forbids  a detail  of the
 scenes of  debauchery which were practised near the hospi-
tal, in some of the  tents which had been appropriated for
the reception of convalescents.   It was not peculiar to this
fever to  produce this morbid excitability of the venereal
appetite.  It  was produced in a much higher degree by the
plague which raged in Messina in the year 1743.
  VII. The lymphatic and glandular system did not escape
without some signs of this disease. I met with three cases
of swellings in the inguinal,  two in the parotid, and one in
the cervical glands: all these patients recovered without a
suppuration of their swellings.   They were extremely pain-
ful in one  case in which no redness or inflammation appear-
ed.  In the others there was considerable inflammation and
hut little pain.
  In one  of the cases of inguinal buboes, the whole force
of the  disease seemed to  be collected into the lymphatic 
68
AN ACCOUNT OF THE
system.  The patient walked about, and had  no fever nor
pain in any part of his body, except in his groin.   In ano-
ther case which came under my care, a swelling and pain
extended from the groin along die spermatic cord into one
of the testicles.  These glandular swellings were not pecu-
liar to this epidemic.  They occurred in die yellow fever
of Jamaica, as described by Dr. Williams, and always with
a happy issue of the disease.*   A similar concentration of
the whole force of the plague in the  lymphatic glands is
taken notice of by Dr. Patrick Russel.
   VIII.  The skin exhibited many marks of  this fever.  It
was preternaturally warm in some  cases, but it was often
preternaturally cool.  In some there was  a distressing cold-
ness in the limbs for two or three days.  The yellow colour
from which  this fever has derived its name, was not uni-
versal.  It seldom appeared where purges had been given
in sufficient doses.   The yellowness rarely appeared before
the third, and generally about the fifth or seventh day of the
fever. Its early appearance always denoted  great danger.
It sometimes appeared first on the neck  and breast, instead
of the eyes.  In one of my patients it discovered itself first
behind one of his ears, and on the crown of his head, which
had been bald for several years.   The remissions and exa-
cerbations of the fever seemed to  have an influence upon
this colour,  for it appeared and disappeared  altogether, or
with fainter or deeper shades of yellow,  two or three times
in the course of the disease.  The eyes seldom escaped a
yellow tinge; and yet I saw a number of cases in which the
disease appeared with  uncommon  malignity and  danger,
without the presence of this symptom.
   There was a clay-coloured appearance in the face,  in
some cases,  which was very different from the yellow co-
lour which  has been  described.   It occurred in  the last
stage of the fever, and in no instance did I see a.recovery
after it.
   There were eruptions of various kinds on the skin, each
of which I shall briefly describe.
   1.  I met with two cases of an eruption on the skin,  re-
sembling that which occurs in the scarlet fever.  Dr. Hume
says, pimples often appear on the pit of the stomach, in the
yellow fever of Jamaica.   I examined the external region
            • Essay on the Bilious or Yellow Fever, p. 35. 
BILIOUS YELLOW FEVER OF 1793.        6.9
of the stomach in many of my patients, without discovering
them.
  2. I met widi one case in which there  was an eruption
of watery blisters, which, after bursting, ended in deep,
black sores.
  3. There was an eruption about the mouth in many peo-
ple, which ended in scabs, similar to those which take place
in the common  bilious fever.  They always afforded a pros-
pect of a favourable issue of the disease.
  4. Many persons had eruptions which resembled mos-
queto bites. They were red and circumscribed.  They ap-
peared chiefly on the arms, but they sometimes extended
to the breast.  Like the yellow  colour of the skin, they ap-
peared and disappeared two or three times in the course of
the disease.
  5. Petechiae were common in the latter stage of the fever.
They sometimes came on in large, and at other times in
small red blotches; but they soon acquired a dark colour.
In most cases they were the harbingers of death.
   6.  Several cases of  carbuncles,  such as occur  in the
plague, came under my notice.  They were large and hard
swellings on the limbs, with a black apex, which, upon
being  opened,  discharged a thin, dark-coloured,  bloody
matter. From one of these malignant sores an haemorrhage
took place, which precipitated the death of the amiable
widow of Dr. John Morris.
   7. A large and painful anthrax  on the back succeeded a
favourable issue of the fever in the Rev. Dr. Blackwell.
   8. I met with a woman who showed me the marks of a
number of small biles on her face and neck, which accom-
panied her fever.
  Notwithstanding this  disposition to cutaneous eruptions
in this disease,  it was remarkable that blisters were much
less disposed to mortify than in  the common nervous fever.
I met with only one case in which a deep-seated ulcer fol-
lowed the application of blisters to the legs.   Such was the
insensibility of the skin  in some people, that blisters made
no impression upon it.
  IX.  The blood in this fever has been supposed to under-
go a change from a healthy to a putrid  state, and many of
its symptoms which have been described, particularly the
hemorrhages and eruptions on the skin, have been ascribed 
70
AN ACCOUNT OF  THE
 to thib supposed putrefaction of the blood.  It would be
 easy to multiply arguments, in addition to those mentioned
 in another place,* to prove that no such thing as putrefac-
 tion  can  take place in the blood,  and  that the symptoms
 which have been supposed to prove  its existence are all
 effects of a sudden, violent, and rapid inflammatory action
 or pressure upon the blood-vessels, and hence the external
 and  internal  haemorrhages.  The petechiae  on the surface
 of the skin depend upon the same cause.  They are no-
 thing but effusions of serum or red blood, from  a rupture
 or preternatural  dilatation of the capillary vessels, f  The
 smell emitted from persons affected by this disease was far
 from being of a putrid nature;  and if this  had  been the
 case, it would not have proved  the  existence of  putrefac-
 tion  in the blood, for a putrid  smell  is often  discharged
 from the lungs, and from the pores in sweat, which is wholly
 unconnected  with a putrid, or perhaps any  other morbid
 state of the blood.   There are plants  which discharge an
 odour which  conveys to the nose a sensation like that of
 putrefaction;  and yet these plants  exist, at the same time,
 in a  state of the most healthy vegetation:  nor  does the
 early putrid smell of a body which perishes with this fever
 prove a putrid change to have taken place in the blood be-
 fore death.  All  animals which die suddenly, and without
 loss of blood,  are disposed to a speedy putrefaction.  This
 has long  been remarked in animals that have been killed
 after a chase,  or  by lightning.  The poisonous air  called
 sqmiel,  which is described  by Chardin, produces,  when it
 destroys life, instant putrefaction. The bodies of men who
 die of violent  passions, or after strong convulsions, or even
 after great muscular exertion,  putrify in a few hours after
 death.  The healthy state of the body depends upon a cer-
 tain state of arrangement in the fluids.   A derangement of
 these fluids  is the natural consequence of the violent and
 rapid motions, or of the undue pressure  upon the solids,
 which have been mentioned.   It occurs in cases  of death
 which are induced by the excessive force of stimulus, whe-
  * Outlines of the phenomena of fever.
  j See Wallis's edition of Sydenham, vol. i. p. 165. vol. ii. p. 52, 94 98 350 •
 De Haen's Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172; Gaubi'i Patho'losna'
 sect. 498; and Dr.  Seybert's inaugural dissertation,  entitled "An Attempt to
disprove the Doctrine  of Putrefaction of the Blood in Living Animals " pub-
 lished in Fhiladelphia, in 1793.                             ' ^ 
BILIOUS YELLOW FEVER OF 1793.        71
ther  it be from  miasmata, or  the  volatile  vitriolic acid
which is supposed to constitute the destructive samiel wind,
or from violent commotions excited  in the body by exter-
nal or internal causes.   The practice among fishermen, in
some countries, of breaking the heads of their fish as soon
as they are taken  out of the water, in order to retard their
putrefaction,  proves  the  truth of the explanation I  have
given of its cause, soon after death.   The sudden extinc-
tion  of life in the fish prevents those convulsive  or violent
motions,  which induce  sudden  disorganization in  their
bodies.  It was observed that putrefaction took place most
speedily after death from the yellow fever, where the com-
motions of the system were not relieved by  evacuations.
In those cases where purges and bleeding had been  used,
putrefaction did not take place  sooner after  death than is
common in any other febrile disease, under equal circum-
stances of heat and air.
   Thus  I have  described  the  symptoms of this  fever.
From the history I have given, it appears that it counter-
feited  nearly all  the acute and chronic forms of disease to
which the human body is subject.   An epitome,  both of
its symptoms  and  its theory, is happily delivered by Dr.
Sydenham, in the following words.  After describing the
epidemic cough, pleurisy,  and peripneumony of 1675, he
adds, " But  in other epidemics,  the symptoms are so slight
from the disturbance raised in the blood  by the morbific
particles contained in the  mass,  that nature being in  a
manner oppressed, is rendered unable to  produce regular
symptoms that are suitable to the disease ; and almost all
the phenomena that happen are irregular,  by reason of the*
entire  subversion of the animal economy; in which case
the fever is often depressed, which, of its own nature, would
be very high.  Sometimes also fewer signs of a fever ap-
pear .than the nature of the disease requires, from a transla-
tion  of the malignant cause, either to the  nervous system,
or to some other parts of the body, or to some of the" juices
not contained in the blood ;  whilst the morbific  matter is
yet turgid."*
   The disease  ended in death in various ways.   In  some
it was sudden; in others it came on  by  gradual approach-
es.  In some the last hours of life were marked with great
pain, and strong  convulsions; but in manv more,  death
             s                           *       '
                * Wallis's edition, vol. i p. C44. 
72
AN ACCOUNT  OF THE
seemed to insinuate itself into the system, with all the gen-
tleness of natural sleep.  Mr. Powell expired widi a smile
on his countenance.  Dr.  Griffitts informed me that Dr.
Johnson exhibited the same symptom in the last hours of
his life.   This placid appearance of the countenance, in
the act of dying, was not new to me.  It frequently occurs
in diseases which affect the brain and nerves.  1 lost  a par
tient, in the year 1791, with the gout, who not only smiled,
but laughed,  a few minutes before he expired.
   I proceed  now to mention some peculiarities  of the
fever, which could not be brought in under any of die fore-
going heads.
   In every case of this disease which came under my notice,
there were evident remissions, or intermissions of die fever,
or of such symptoms as were substituted for fever.  I have
long considered, with Mr. Senac,  a tertian as the only ori-
ginal type of  all fevers.   The bilious yellow  fever indicat-
ed its descent from this parent disease.   I met with many-
cases of regular tertians, in which the patients were so well-
on  the intermediate days as to go  abroad.   It appeared in
this form in Mr. Van Berkel, the  minister of the United
Netherlands.   Nor was this mild form of the fever  devoid
of danger. Many died who  neglected it, or who took the
common remedies for intermittents to cure it.  It generally
ended in a remittent before it destroyed the patient.   The
tertian type discovered itself in some people after the more
violent symptoms of the fever had been subdued, and con-
tinued in them for several weeks.  It changed from a ter-
tian to a quartan  type in Mr. Thomas Willing, nearly a
month after his recovery from the more acute and inflam-
matory symptoms of the disease.
  It is nothing new for a malignant fever to appear in the
form of a tertian.  It  is frequently the garb of the plague.
Riverius describes a tertian fever which proved fatal on the
diird day, which was evidently derived from the same ex-
halation which produced a continual malignant fever.*
  The remissions were more evident in this, than  in the
common bilious fever.   They generally occurred  in the
forenoon.   It was my misfortune  to be deprived, bv the
great number of my  patients, of that  command of" time
which was necessary  to  watch the exacerbations  of this
* De Febre Pestilenti, vol. xi. p. 93. 
          BILIOUS YELLOW FEVER OF 1793.        73

fever  under all their various changes, as to time, force, and
duration.  From all the observations that were  suggested
by visits,  at hours that were seldom left to my choice,  I
was led to conclude, that the fever exhibited, in different
people, all that variety of forms which has been described
by Dr. Cleghorn, in his account of the tertian fever of Mi-
norca.  A violent exacerbation on  even days was evidently
attended with more danger than on odd  days.   The same
thing was observed by Dr. Mitchell, in the yellow fever of
Virginia,  in the year 1741.   " If  (says he)  the exacerba-
tions  were on ofljnal days, they generally died in the third
paroxysm, or the sixth day; but if on unequal days,  they
recovered on the seventh."
   The deaths which occurred on the 3d, 5th, and 7th days,
appeared frequently to be the effects of the commotions, or
depression, produced in the system on the 2d, 4th,  and 6th
days.
   An apparent  remission on the  3d day was frequently
such as to beget a belief that the disease had run its course,
and that  all danger was over.   A violent  attack of the
fever on the 4th day removed this deception ;  and,  if a re-
laxation had taken place in the use of proper remedies on
the 3d day, death frequently occurred on the 5th or the 7th.
   The termination of this fever in  life and death was much
more frequent on the  3d,  5th, 7th, 9th, and  11th days,
than is common in the mild remitting fever.  Where death
occurred on the even days, it seemed to be the effect of  a
violent  paroxysm of the fever, or of  great vigour of con-
stitution,  or of the force of medicine which protracted
some of the motions of life  beyond the close of the odd
days which have been mentioned.
  I think I observed the fever to  terminate  on the third
day more frequently in August, and during the first ten days
in September, than it did after the weather became cool.
In this it resembled the common bilious remittents of our
city, also  the simple tertians described by Dr. Cleghorn.*
The danger seemed to be in proportion to the tendency of
the disease to a speedy crisis; hence more died in August,
in proportion to the number who were affected, than in Sep-
tember  or October,  when  the disease was left to itself.
But, however strange after this remark  it may appear, the
                 • Diseases of Minorca, p. 185.
   VOL. ITI.               !C 
74
AN  ACCOUNT OF THE
disease yielded  to  the  remedies which finally subdued it
more speedily and certainly upon its first appearance in the
city, than it did two or three weeks afterwards.
   The disease continued for fifteen, twenty, and even thirty
days,  in  some people.   Its duration was much influenced
by the weather, and by the use or neglect of certain remedies
(to be mentioned hereafter) in the first stage of the disease.
   It has been common  with authors to divide  the symp-
toms of this fever into three different stages.  The order I
have pursued in the history of those symptoms will render
this division unnecessay.  It will,  I hope,  be more useful
to divide  the patients affected with the  disease into three
classes.
   The first includes those in whom the stimulus of the
miasmata produced coma, languor, sighing, a disposition to
syncope, and a weak or  slow puls*e.
   The second includes  those in whom the miasmata acted
with less force, producing great pain in the head, and other
parts  of the body; delirium, vomiting,  heat, thirst, and a
quick, tense, or full pulse,  with obvious remissions or in-
termissions of  the fever.
   The third class includes all those persons in whom the
miasmata acted so feebly as not to confine them to uiek
beds or houses.   This class of persons affected by the yel-
low fever was very numerous.  Many of them recovered
without medical aid, or by the use of domestic prescriptions;
many of them recovered in consequence of a spontaneous
diarrhoea, or plentiful sweats;  many were saved by mode-
rate bleeding and purging;  while some died, who conceiv-
ed their  complaints to be  occasioned by a  common cold,
and neglected to take proper care of themselves,  or to use
the necessary means for  their recovery.  It is not peculiar
to the yellow  fever to produce this feeble operation upon
the system.  It has been observed in the southern states of
America, that in those  seasons in which the common bi-
lious fever is epidemic,  « no body is quite well,''  and that
what are called in those states " inward fevers,"  are uni-
versal.  The small-pox, even in the natural way,  does not
always confine the patient;  and thousands pass through the
plague without being confined to their beds or houses   Dr
Hodges prescribed for this class of patients in his parlour
in London, in the year 1665, and  Dr. Patrick Russel did 
         BILIOUS  YELLOW FEVER OF  1793.       75

the same from a chamber  window fifteen feet above the
level of the street at Aleppo.   Notwithstanding the mild
form the plague put on in these cases, it often proved fatal
according to Dr.  Russel.   I have introduced these facts
chiefly with a view of preparing the reader to reject the opi-
nion that we had two species of fever in the city at the same
time; and to show that the yellow fever appears in a more
simple form than with  " strongly marked"  characters; or,
hi other words, with a  yellow skin and a black vomiting.
  It is remarkable that this fever always found out the weak
part of every constitution it attacked. The head, the lungs,
the stomach, the bowels, and the limbs, suffered more or
less, according as they were more or less debilitated by pre-
vious inflammatory or nervous diseases, or by a mixture of
both,  as in the gout.
  I have before remarked, that the influenza, the scarlatina,
and a mild  bilious remittent, prevailed in the city,  before
the yellow fever made its appearance. In the course of a
few weeks they all disappeared, or appeared with symptoms
of the yellow fever;  so that, after the first week of Septem-
ber, it was the solitary epidemic of the city.
   The only case like influenza which I saw after the 5th of
September, was in a girl of 14 years of age, on the 13th of
the month.  It came on with a  sneezing aud cough.  I was
called to her on the third day of her disease.   The instant
I felt  her pulse, I pronounced her  disease to be the yellow
fever.  Her father was offended with this opinion, although
he lived in  a highly infected neighbourhood,  and objected
to the remedies I prescribed for  her.   In  a few  days she
died.   In the course of ten days, her father  and sister were
infected, and both died,  I was informed,  with the  usual
symptoms of the yellow fever.
  It has been an axiom in medicine, time immemorial, that
no two fevers of unequal force  can exist long together in
the same place. As this axiom seems to have been forgot-
ten by many of the physicians of Philadelphia, and as  the
ignorance or neglect of it led to that contrariety of opinion
and practice, which unhappily took place in the treatment
of the disease,  I hope I shall be excused  by those physi-
cians, to whom this  fact is as familiar as the most simple
law of nature, if I  fill a few pages with proofs of it, from
practical writers. 
76
AN ACCOUNT  OF TH£
  Thucydides long ago remarked, that the plague  chased
all other diseases from Athens, or obliged them to  change
their nature, by assuming some of its symptoms.
  Dr. Sydenham makes the same remark upon the plague
in London, in 1665.  Dr. Hodges,  in his account of the
same plague, says, that " at the rise  of the plague all other
distempers went into it, but that, as its declension, it dege-
nerated into others, as inflammations, head-ach,  quinsies,
dysenteries, small-pox, measles, fevers, and hectics, where-
in the plague yet predominated."*
  During the prevalence of the plague in Grand Cairo, no
sporadic disease of any kind makes its appearance.  The
same observation is made by Sauvage, in his account of the
plague at Alais, in the province of Languedoc.f
  The small-pox, though a disease  of less force than the
plague, has often chased it  from Constantinople, probably
from its being in a declining state. But this exclusive pre-
valence of a single epidemic is not confined to the  plague
and small-pox;  Dr. Sydenham's writings are full of proofs
of the dominion of febrile diseases over each other.  Hence,
after treating upon a  symptomatic pleurisy which some-
times accompanied a slow  fever, in the year 1675,  and
which had probably been injudiciously treated by some of
those physicians who prescribe for  the  name of a  disease,
he delivers the following aphorism: " Whoever, in the cure
of fevers, hath not always in view the  constitution of the
year, inasmuch as it tends to produce some particular epi-
demic disease, and likewise to reduce all the cotemporary
diseases to its own form  and likeness, proceeds in an un-
certain  and fallacious way. "J It appears further, from the
writings of this excellent physician, that where the monarchy
of a single disease was not immediately acknowledged, by
a sudden retreat of all cotemporary diseases, they were for-
ced to do homage to  it, by wearing its  livery.   It would
be easy to multiply proofs of this  assertion, from  the nu-
merous histories of epidemics which* are  to be found in his
works.   I shall mention only one or two of them.  A con-
tinual fever, accompanied by a dry skin, had prevailed for
  * Dr. Hodges' Account of the Plague in London, p. 26.
  fSedhoc observatu dignum fuit, omnes alios morbos acutos durante peste
siluisse, et omnes morbos acutos e pestis genere Suisse. Nosolotna Methodica,
vol. i. p. 416.
  i Vol. i. p. 340. 
BILIOUS YELLOW FEVER  OF  1793.
77
some time in the city of London. During the continuance
of this fever, the regular small-pox made its appearance. It
is peculiar to the small-pox,  when of a distinct nature, to
be attended  by irregular sweats  before the eruption of the
pock.  The continual fever now put on a new symptom.
It was attended by  sweats in its first stage,  exactly  like
those which attended the eruptive fever of the small-pox.*
This despotism of a powerful epidemic extended  itself to
the most trifling indispositions.   It even blended itself, Dr.
Sydenham tells  us, with the commotions excited in the
system by the suppression of the lochia, as well as with the
common puerperUe fever, f Dr. Morton has left testimonies
behind him, in different parts of his works, which establish,
in the most ample manner, the truth of Dr. Sydenham's ob-
servations. Dr. Huxham describes the small-pox as blend-
ing  some of its symptoms with those of a slow fever, at
Plymouth, in the  year  1729.$   Dr. Cleghorn mentions a
constitution of the air at Minorca, so highly inflammatory,
" that not only tertian fevers, but even a  common hurt or
bruise required more plentiful evacuations than ordinary."§
Riverius informs us, in his history of a pestilential fever that
prevailed in France, that " united itself with phrenitis, an-
gina, pleurisy,  peripneumony,  hepatitis,  dysentery,  and
many other diseases. "||
   The bilious remitting fever which prevailed in Philadel-
phia, in 1780, chased away every other febrile disease ; and
the scarlatina anginosa which prevailed in our city, in 1783
and  1784, furnished a  striking proof of the influence of
epidemics over each other.   In the account which I pub-
lished of this disease, in the year 1789, there are the follow-
ing  remarks.   " The  intermitting fever which made its
appearance in August was not  lost during  the  month of
September.   It continued to prevail, but widi several pe-
culiar symptoms.  In many persons it was accompanied by
an eruption  on the skin, and a swelling of the hands and
feet.  In some it  was attended with sore throat,  and pains
behind the ears.   Indeed such  was the prevalence  of the
contagion which produced  the  scarlatina  anginosa,  that
  • Vol. i. p. 352.
  t Vol. ii. p. 164.  See also p.  1, 109, 122, 204,  212, 233, 274, 355, 358-9,
snd 436.
  t De Acre et Morb. Epidem.  p. 33, 34.                § Page 285
  || De Febro Pestilenti, vol ii. p. 95 
78
AN  ACCOUNT OF THE
 many hundred people complained of sore throats,  without
 any other symptom of indisposition.  The slightest excit-
 ing cause, and particularly cold, seldom failed of  produc-
 ing the disease."*
   I shall mention only one more audiority in favour of the
 influence of a single epidemic upon diseases.   It  is taken
 from Mr. Clark's Essay on the Epidemic Disease of Lying-
 in Women of the years 1787 and 1788.  " There does not
 appear to be any thing in a parturient state which can pre-
 vent women from being affected by the general causes of
 disease at that time; and should they become ill, their com-
 plaints will  probably partake of the  nature of the reigning
 epidemic"!  I have said that the fever sometimes put on
 the symptoms  of dysentery,  pleurisy,  rheumatism, colic,
 palsy, and even of the locked jaw. That these were not ori-
 ginal diseases, but symptomatic affections only of the reign-
 ing epidemic, will appear from other histories  of bilious fe-
 vers.  Dr. Balfour tells us, in his account  of the intestinal
 remitting fever of Bengal, J that it often appeared with symp-
 toms of dysentery, rheumatism,  and pleurisy. Dr. Cleghorn
 and Dr. Lind mention many  cases of the bilious fever ap-
 pearing in the form of a dysentery.  Dr. Clark ascribes the
 dysentery, the diarrhoea, the  colic,  and even the palsy, to
 the same cause which produced the bilious  fever in the
 East- Indies ;§ and Dr. Hunter, in his Treatise  upon the
 Diseases of Jamaica, mentions the locked jaw as one of its
 occasional symptoms.   Even the different grades of this
 fever,  from the mildest intermittent to the  most acute  con-
 tinual fever, have been distinctly traced by Lancissi to the
 same  marsh exhalation. ||
  However irrefragably these numerous facts and  authori-
ties established the assertion  of the prevalence of but one
powerful  epidemic at a time, the proposition  will  receive
fresh support, from attending to the effects of two impres-
sions of unequal force  made upon the  system at the same
time:  only one of them is felt;  hence the  gout is  said to
cure all other diseases.  By  its superior pain it destroys
sensations of a less painful nature.  The  small-pox  and
measles have sometimes existed together in the body;  but
  •Vol. 1.            f Page 28.              * Page 132.
  § Observations on the Diseases m Lon^ Voyages to the East-Indies vol i D
13. 14, 48, 151.  vol. ii. p. 99,318, and 320.                  *    P'
  jj Lib. ii. cap. v. 
         BILIOUS  YELLOW  FEVER  OF  1793.       79

 this has, I  believe,  seldom  occurred,  where one  of them
 has not been the predominating disease.*  In this respect,
 this combination of epidemics only conforms to the general
 law which has been mentioned.
   I beg pardon for the length of this digression. I did not
 introduce it to  expose  the  mistakes of those  physicians,
 who found as many diseases in our city as the yellow fever
 had symptoms,  but to vindicate myself from the charge of
 innovation, in having uniformly and unequivocally asserted,
 after the first week in September, that the yellow fever was
 the only febrile disease which prevailed in the city.
   Science has much to deplore from the multiplication of
 disease.  It is as repugnant to truth in medicine,  as poly-
 theism  is to truth in religion.   The physician who con-
 siders every different affection of the different systems in the
 body, or every affection of different parts of the same sys-
tem, as distinct diseases, when they arise from one cause,
resembles the Indian or African savage, who considers wa-
 ter, dew, ice,  frost,  and snow, as distinct essences;  while
 the physician who considers the morbid affections  of every
 part of the body (however diversified they may  be in their
 form or degrees) as derived from one cause, resembles the
 philosopher who considers dew,  ice,  frost,  and snow, as
 different modifications of water, and as derived simply from
 the absence of heat.
   Humanity has likewise  much  to deplore  from  this pa-
 ganism  in medicine.  The sword will probably  be sheath-
ed for ever, as an instrument of  death,  before  physicians
will cease to add to the mortality of mankind, by prescrib-
ing for the  names of diseases.
   The facts I  have delivered upon this subject  will  admit
of a very important application to  the cure, not  only  of the
yellow fever, but of all other acute  and  dangerous epide-
mics.  I shall hereafter assign a final cause  for the law  of
epidemics which has been mentioned, which will discover
a union  of the goodness of the Supreme Being with one of
 the greatest calamities of human life.
  All ages  were affected by this fever, but persons between
 fourteen and forty years of age were most subject  to'it.
Many old people had it,  but it was not so fatal to them  as
to robust persons in middle life.   It affected children of all,
         * Hunter on the A'enereal Disease, Introduction, p 3. 
80
AiT ACCOUNT OF THE
ages.  I met with a violent case of the disease in a child
of four mondis, and a moderate case of it, in a child of but
ten weeks old.  The latter had a deep yellow skin.  Both
these children recovered.
  The proportion of children who suffered by this fever
may be conceived from a single fact.  Seventy-five persons
were buried in the grave-yard of the Swedish church in the
months of August, September and October, twenty-four
of whom were children. They were buried chiefly in Sep-
tember and  October ;  months in which children generally
enjoy good health in our city.
  Men were more subject to  the disease  than women.
Pregnancy seemed to expose women to it.
  The refugees from the  French West-Indies universally
escaped it.   This was not the  case  with the natives of
France, who had been  settled in the city.
  It is nothing new for epidemics to  affect persons of one
nation, and to pass by persons of other nations, in the same
city or country. At Nimeguen,  in the year 1736, Deigner
informs us, that the French people (two old men excepted),
and the Jews,  escaped a  dysentery which  was universal
among persons  of all other nations.  Ramazini tells us, that
the Jews at Modena escaped a tertian fever which affected
nearly all the other inhabitants of the town.  Shenkius says,
that the Dutch and Italians escaped a plague, which pre-
vailed for two  years in one of the  towns of  Switzerland;
and Dr.  Bell,  in  an  inaugural  dissertation, published at
Edinburgh,  in 1779, remarks, that the jail fever, which at-
tacked the soldiers of the  Duke of Buccleugh's regiment,
spared the French prisoners who were guarded by them. It
is difficult to account for these facts.  However numerous
their causes may be, a difference  in diet, which is  as much
a distinguishing mark of nations  as dress  or  manners,  will
probably  be  found to be one of them.
  From the accounts of the yellow  fever which had been
published by many writers, I  was led to believe  that the
negroes in our city would escape it.  In consequence of this
belief, I published the following extract  in the American
Dafly Advertiser,  from  Dr.  Lining's History  of the Yellow
Fever, as it had four times appeared in  Charleston, in South
Carolina.
  « There is something very singular  (says the doctor) in 
          BILIOUS YELLOW FEVER OF 1793.        81

 the constitution of the negroes,  which  renders them not
 liable to tiiis fever; for though many of them were as much
 exposed as the nurses to the infection, yet I never knew of
 one instance of this fever among them, though they  are
 equally subject with the white people to the bilious fever."*
  A day or two after this  publication the following letter
 from the mayor of the city, to Mr.  Claypoole, the printer
 of the Mail, appeared in his paper.

 "Sir,
        "It is with peculiar satisfaction that I commu-
 nicate to the public, through  your paper, that the Afri-
 can  Society, touched  with  the distresses  which arise
 from  the  present  dangerous disorder,   have  voluntarily
 undertaken to  furnish nurses to attend  the afflicted;  and
 that,  by applying to Absalom Jones and  William
Gray,  both members of that  society,  they may be sup-
plied.
                             MATTH. CLARKSON,
 September 6th, 1793.                         Mayor.

  It was not long after these worthy  Africans undertook
 the execution of their humane offer of services to the sick
 before I was convinced I had been mistaken.  They took
 the disease in common with die white people, and many of
 them died with it.  I think I observed the greatest number
of them to sicken after the mornings and evenings became
 cool.  A large number of them were my patients.   The
disease was lighter in them than in white people.   I met
 with no  case of haemorrhage in a black patient.
  The tobacconists and persons who used tobacco did not
escape the  disease.   I observed snuff-takers to be  more
devoted to their boxes than usual, during the prevalence of
 die fever.
  I have remarked, formerly, that servant maids suffered
 much by the disease.  They were the only patients I lost
 in several large families.   I ascribe their  deaths to the fol-
 lowing causes:
  1st. To  the  great and  unusual debility induced  upon
 their systems by labour in  attending their masters and mis-
   • Essay9 and Observations, Physical and Literary, voj. xi. page 409
   '.'OL. TIT.               T. 
82
AN  ACCOUNT OF THE
tresses, or their children. Debility, according to its degrees
and duration, seems to have had the same effect upon the
mortality of this fever that it has upon the mortality of an
inflammation of the lungs.   When it  is moderate  and of
short duration, it predisposes only to a common pneumony;
but when it is violent and  protracted,  in its  degrees and
duration, it predisposes a pulmonary consumption.
  2dly.  To their receiving large quantities of impure air
into their bodies,  and in a most concentrated state,  by be-
ing obliged to perform the most menial offices  for the sick,
and by washing, as well as removing  foul linen, and the
like.
  3dly.  To their being  left more  alone in confined or dis-
tant rooms, and thereby  suffering from depression of spirits,
or the want of a punctual supply of food and medicines.
  There did not appear to be any advantage from smelling
vinegar, tar, camphor,  or volatile  salts,  in preventing the
disease.   Bark and wine were equally  ineffectual for that
purpose.  I was called to many hundred people who were
infected  after using one or  more of diem.   Nor did the
white washing walls secure families from the disease.   I am
disposed to believe garlic was the only substance that was
in any degree useful in  preventing it.   I met  with several
persons  who chewed it constantly, and who were much ex-
posed to the miasmata without being infected. All other sub-
stances seemed to do harm  by begetting a false confidence
in the mind, to the exclusion of more rational preservatives.
I have suspected further, that  such of them as were of a
volatile nature helped to spread the disease by affording a
vehicle for miasmata through the air.
   There was great mortality in all those families who lived
in wooden houses.   Whether this arose from the small size
of these houses, or from the want of cleanliness of the peo-
ple who occupied them, or from the miasmata  becoming
more accumulated,  by adhering to the wood,  I am unable
to determine.   Perhaps it was the effect of the  co-operation
of all three of those causes.
   I have said, formerly, that intemperance in drinking pre-
disposed to the disease ; but there were several instances of
persons having escaped  it  who were constantlv under the
influence of strong  drink.  The stimulus of ardent spirits
probably predominated over the stimulus of the miasmata. 
          BILIOUS YELLOW  FEVER OF 1793.       83

 and thus excited an artificial fever which defended the sys-
 tem from that which was epidemic.
   I heard of some sea-faring  people who lived  on board
their vessels  who  escaped the disease.   The  smell of the
tar was  supposed  to have  preserved them;  but, from its
being ineffectual in other cases, I am disposed to ascribe
their escape to the  infected air of the city being destroyed
by a mixture with the water of the Delaware.
   Many people who were infected in the city, were attack-
ed by the disease in the country, but they did not  propa-
gate it,  even to persons who  slept  in the same room with
them.
   Dr. Lind informs us, that many persons escaped the yel-
low fever  which prevailed in  Pensacola in the year 1765,
by retiring to the ships which lay in the harbour, and that
when the disease had been taken, the pure air of the water
changed it into an  intermitting fever.* The same changes
have frequently been produced in malignant fevers, by send-
ing patients infected with them from the foul air  of a city,
into the pure air of the country.
   Persons confined in  the house of employment,  in  the
hospital, and in  the jail,  escaped the fever.  The airy and
remote situation of those buildings was probably  the chief
means of their preservation.   Perhaps they derived addi-
tional security from their simple diet, their exemption from
hard labour, and from being constantly sheltered from heat
and cold.
   Several families, who shut up their front and back doors
and windows, and  avoided going out of their houses except
to procure provisions, escaped  die disease.
   I have taken some pains to  ascertain, whether any class
of tradesmen escaped the fever, or whether there was any
species of labour which protected  from it.  The result of
my inquiries is  as follows: three  butchers  only, out of
nearly one hundred who remained in the city, died with die
disease.   Many of them attended the markets every day.
Two painters who worked  at their business during the
whole time of the prevalence of the fever, and in  exposed
situations, escaped it.  Out of forty scavengers who were
employed in  collecting  and carrying away the dirt of the
streets, only one was affected by the fever and died.  Very
• Diseases of Warm Climates, p. 169. 
 84              AN  ACCOUNT OF THE

 few grave-diggers, compared with the number who were
 employed in  that business,  were infected;  and it is well
 known, that scarcely an instance was heard of persons tak-
 ing the disease, who were constantly employed in digging
 cellars.  The fact is not new that grave-diggers escape  ma-
 lignant fevers. It is taken notice of by Dr. Clark.
   It was said by some physicians in the public papers, that
 the neighbourhood of the grave-yards was more  infected
 than other parts of the city.   The reverse of this assertion
 was true in several cases, owing probably to the miasmata
 being diluted and weakened by its mixture with the air of
 the grave-yards :  for this air was pure,  compared with that
 which stagnated in the streets.
   It was said further, that the disease was propagated by
 the inhabitants assembling on Sundays for public worship;
 and, as a proof of this assertion,  it was reported, that the
 deaths were more numerous on Sundays than on other days;
 occasioned by the infection received on  one Sunday produc-
 ing death on the  succeeding first day  of the week.  The
 register of the deaths shows that this was not the case. I am
 disposed to believe that fewer people sickened on Sundays,
 than on any other  day of the week; owing to the general
 rest from labour,  which I have before  said was one of the
 exciting causes  of the disease.   From some facts to be
 mentioned presently, it will appear probable, that places of
 public worship, in consequence of their size, as well as of
 their being shut up during the  greatest part  of the week,
 were the freest from miasmata of any houses in the citv.  It
 is agreeable to discover in this, as  well as in all other cases
 of public and private duty, that the means of health and
 moral happiness  are in no one instance opposed  to each
 other.
   The disease, which was first confined to Water-street,
 soon spread  through  the whole  city.   After the  15th  of
 September, the atmosphere of  every street in the city was
 charged with miasmata; and there were few citizens in ap-
 parent good health, who did not exhibit one or more of the
 following marks of their presence in their bodies.
   1. A yellowness in the eyes, and a sallow colour upon
 their skin.                                          A
   2. A preternatural quickness in  the pulse.  I found but
two exceptions to  this remark, out of a great  number of 
BILIOUS YELLOW FEVER OF 1793.        85
persons whose pulses I examined.  In one of them, it dis-
covered several preternatural intermissions in the course of
a minute. This quickness of pulse occurred in the negroes,
as well as in the white people.   I met with it  in a woman
who had had the yellow fever  in 1762.  In two women,
and in one  man above 70, the pulse beat upwards of 90
strokes in a minute.   This preternatural  state of the pulse
during the  prevalence of a pestilential fever, in persons in
health, is taken notice of by Riverius.*
  3.  Frequent and copious discharges by the skin of yellow
sweats. In some persons, these sweats sometimes had  an
offensive smell, resembling that of the washings of a gun.^
  4.  A scanty discharge of high-coloured or turbid urine.
  5.  A deficiency of appetite,  or a greater degree of it than
was natural.
  6.  Costiveness.
  7.  Wakefulness.
  8.  Head-ach.
  9.  A preternatural dilatation of the pupils.  This was
universal.   I was much struck  in observing the  pupil in
one of the eyes of a young man who called upon me for
advice, to be of an oblong figure.  Whether it was natural,
or the effect  of the  miasmata  acting on his  brain, I could
not determine.
  It will be thought less  strange that the miasmata should
produce these changes in the  systems of persons who re-
sided constantly in the city, when I add, that many country
people, who spent but a few hours in the streets in the day,
in attending the markets, were infected by the disease, and
sickened and died after  they returned  home ;  and that
others, whom business compelled to  spend a day  or two in
the city during the prevalence of the fever, but who escaped
an attack of it,  declared that they were indisposed, during
the whole time, with languor or head-ach.
  I was led to observe and record the above effects of the
 miasmata upon persons in apparent good health,  by a fact
 I met with in Dr. Mitchell's History of  the Yellow Fever
 in Virginia, in the Year 1741.  In that fever, blood drawn
 from a vein was always dissolved.   The same state of the

  •  "Pulsus sanorum pulsibus similes admodum, periculosi"—T)e Febre Pes- 
86
AN  ACCOUNT OF  THE
blood was observed in many persons who had been expos-
ed to the miasmata, who discovered no other symptom of
the disease.
  A woman  whom I had formerly cured of a mania, who
lived in an infected neighbourhood,  had a fresh attack of
that disease, accompanied by an unusual menstrual flux.  I
ascribed both these complaints to the action of the miasma-
ta upon her system.
  The smell  emitted from a patient, in a clean room, was
like that of the small-pox, but in most cases of a  less dis-
agreeable nature.   Putrid smells in sick rooms were the
effects of the  excretions,  or  of  some other  filthy  matters.
In small rooms, crowded in some instances with four or five
sick people, there was an effluvia that produced giddiness,
sickness at stomach, a weakness of the limbs, faintness, and
in some cases a diarrhoea.  I met with a foetid breath in one
patient,  which was not the effect of that medicine which
sometimes produces it.
  The state of the atmosphere, during the whole month of
September, and the first two weeks in October, favoured
the accumulation of the miasmata in the city.
  The register of the weather shows how little the air was
agitated by winds during the above time.   In vain  were
changes in the moon expected to alter the state of the air.
The light of the morning mocked the hopes that were rais-
ed by  a cloudy sky in the evening.  The  sun ceased to
be viewed with pleasure.  Hundreds  sickened every day
beneath the influence of his rays : and even where they did
not excite the disease, they produced a languor in the body
unknown to the oldest inhabitant of the city,  at the same
season of the  year.
  A meteor was seen at two o'clock in the morning, on or
about the twelfth of September.  It fell between Third street
and the hospital, nearly in a  line with Pine street.  Mos-
quetoes (the usual attendants of  a sickly autumn) were un-
commonly numerous.   Here and there a dead cat added to
the impurity of the air of the streets.  It was supposed those
animals perished with hunger in  the city,  in consequence of
so many houses being deserted by the inhabitants, who had
fled into the country; but the observations  of subsequent
years made it more probable they were destroyed by the
same morbid  state of the atmosphere which .produced the
reigning epidemic. 
BILIOUS YELLOW FEVER OF  1793.       87
  It appears further, from the register of the weather,  that
there was no rain between the 25th of August and the 15di
of October, except a few drops, hardly enough to lay the
dust of the  streets, on the 9th of September, and the 12th
of October.  In consequence of this drought,  the  springs
and wells failed in many parts of the country.  The dust in
some  places extended two  feet below  the  surface of the
ground.  The pastures were deficient, or burnt up. There
was a scarcity of autumnal  fruits in the neighbourhood of
the city.  But while vegetation drooped or died from the
want of moisture in some places, it revived with preterna-
tural vigour from unusual  heat in  others.   Cherry-trees
blossomed, and  apple, pear, and plum-trees bore young
fruit in several gardens in Trenton, thirty miles from Phila-
delphia, in  the month of October.
  However inoffensive  uniform heat,  when agitated  by
gentle breezes, may be,  there is, I believe, no record of a
dry, warm, and stagnating air having existed for any length
of time without producing  diseases.  Hippocrates, in de-
scribing a pestilential fever, says the year  in which it pre-
vailed was  without  a breeze of wind.*  The same state of
the atmosphere,  for six weeks,  is mentioned in many of the
histories of the plague which prevailed in London, in 1665. f
Even the sea air itself becomes unwholesome by  stagna-
ting ; hence Dr.  Clark informs us, that sailors become sick-
ly after long calms in  East-India  voyages.:}:   Sir  John
Pringle delivers the following aphorism from a number of
similar observations  upon this  subject: " When the  heats
come on soon, and continue throughout autumn,  not mo-
derated  by  winds or rains, the season proves sickly, distem-
pers appear early, and are dangerous. "§
   Who can review this  account of  the universal diffusion
of the miasmata  which produced this disease, its universal
effects upon persons apparently in good healdi, and its accu-
mulation and concentration, in consequence of the calmness
of the air,  and believe that it was possible for a febrile dis-
ease to exist at that time in our city that was not derived
from that source ?
   The West-India writers upon the yellow fever have said

  '  " Sine aura, usque annus fait."—Epid 3.
  T  letter from Sir John Bernard to Dr. 1'loyor, p. 233.      * Vol. i- p- 5.
  §  Diseases of the Army, p. 5, of the 7th London edition. 
88
AN ACCOUNT OF THE
that it is seldom taken twice,  except by persons who have
spent some years in Europe or America in the interval be-
tween its first and second attack.  I directed my inquiries
to this question, and I now proceed to mention the result of
them.   I met  with five persons, during the prevalence of
the disease,  who had had it formerly,  two of them in the
year 1741, and three in 1762, who escaped it in 1793,  al-
though they were all more or  less exposed to the infection.
One of them felt a constant pain in her  head while the dis-
ease was in her family.  Four  of them were aged,  and of
course less liable to be acted upon  by  the  miasmata than
persons in early or middle life.  Mr. Thomas Shields fur-
nished an unequivocal proof that the disease could be taken
after an interval of many years.  He had it in the year 1762,
and narrowly escaped  from a  violent attack  of it this year.
Cases of reinfection were very common during the preva-
lence of this fever.  They occurred most frequently where
the first attack had been light.   But they succeeded attacks
that were severe in Dr. Griffitts, Dr. Mease, my pupil Mr.
Coxe, and several others, whose cases came under my notice.
   I have before remarked that the miasmata sometimes ex-
cited a  fever as soon as they were taken  into the body,
but that they often lay there from one to sixteen days before
they produced the disease.   How long they existed in the
body after a recovery from  the fever I could not tell,  for
persons who recovered were, in most cases, exposed to their
action from external sources.    The preternatural dilatation
of the pupils  was a certain  mark  of  the  continuance of
some portion  of them in the system.   In one person who
was attacked with the fever on the night of the 9th of Octo-
ber,  the pupils did not contract to their natural dimensions
until the 7th of November.
   Having described the effects of  the miasmata upon the
body, I proceed now to mention the changes induced upon
it by death.
   Let  us first take a  view of it as  it appeared soon after
death.   Some new light  may perhaps be thrown upon the
proximate cause of the disease by this mode of examining
the body.
   My information upon this subject was derived from the
attendants upon the sick, and  from two African citizens
who were employed in burying the dead,  viz.   Richard 
BILIOUS YELLOW FEVER OF 1793.
89
Allen and Absalom Jones.   The coincidence of the infor-
mation I received from different persons satisfied me  that
all that I shall here relate is both accurate and just.
  A deep yellow colour appeared in many cases within a
few minutes after death.  In some the skin became purple,
and in others black.  I heard of one case in which the body
was  yellow above,  and black  below its middle.   In some
the skin was as pale as it is in  persons who die of common
fevers.  A placid countenance was observed in many, re-
sembling that which occurs in  an easy and healthful sleep.
   Some  were  stiff within one hour after death.  Others
were not so for six hours afterwards.  This sudden stiffness
after death,  Dr. Valli informs  us, occurred in persons who
died of the plague in Smyrna,  in the year  1784.*
   Some grew cold soon after  death,  while others retained
a considerable degree of heat for six hours, more especially
on their backs.
   A stream of tears appeared on the cheeks of a young wo-
man, which seemed to have flowed after her death.
   Some putrefied  in a short  time after their dissolution,
but others had no smell for twelve, eighteen,  and twenty
hours afterwards.   This absence of smell occurred in those
cases in which evacuations had been used without success in
the treatment  of the disease.
   Many discharged large quantities of black matter  from
the bowels, and others blood from the nose, mouth, and
bowels, after  death.  The frequency of these discharges
gave rise to the practice of pitching the joints of the coffins
that were used to bury the dead.
   The morbid appearances of the internal parts of the body,
as exhibited by dissection after death from the yellow fever,
iire different in different countries, and in the same countries
indifferent  years.   I consider them  all as effects only of a
stimulus  acting upon the whole system, and  determined
more or less by accidental circumstances  to particular vis-
cera.  Pernaps the stimulus of the miasmata determines the
9/dids more violently in most cases to the liver, stomach, and
 bowels, and thereby disposes them more than other parts to
 it flammation  and mortification,  and  to  similar effusions
 and eruptions widi those which take pktee on  the  skin.
 There can  be no doubt of the miasmata  acting  upon the
             • Experiments on Animal E!oc;r'.c'itv, p 90,
    VOL.  I IT.               m 
90               AN ACCOUNT  OF THE
liver, and thereby altering the qualities of the bile.  I tran-
scribe, with great pleasure, the following account of the state
of the bile in a female slave of forty years of age, from Dr.
Mitchell's History of the Yellow Fever, as it prevailed  in
Virginia  in the years 1737 and 1741,  inasmuch as it was
part of that clue which led me to adopt one of the remedies
on which much of the success of my practice depended.
   " The  gall bladder (says the doctor) appeared outwardly
of a deep yellow, but within was full of  black ropy coagu-
lated atrabilis, which sort of substance obstructed the pori
biliarii, and ductus choledochus.  This atrabilis was hardly
fluid, but upon opening the gall bladder,  it retained its form
and  shape, without being evacuated,  being of the consist-
ence of a  thin extract, and, within, glutinous and ropy, like
soap when boiling.  This black  matter seemed so much un-
like bile,  that I doubted if there were any bile in the gall
bladder.   It more resembled bruised or mortified blood,
evacuated from the mortified parts of the liver, surrounding
it, although it would stain a knife or probe thrust into it of
a yellow colour,  which with its ropy consistence, seemed
more peculiar to a bilious humour."
  The same appearance of the bile was discovered in seve-
ral other subjects dissected by Dr. Mitchell.
  The liver, in the above-mentioned slave, was  turgid and
plump on its outside, but on its concave surface, two-thirds
of it were of a deep black colour,  and round the gall  blad-
der it seemed to be mortified and corrupted.
  The duodenum was  lined on  its inside,  near the gall
bladder, with a  viscid ropy bile,  like that which has been
described.  Its villous coat  was lined  with a thick fur or
slime, which, when scraped or peeled off, the other vascu-
lar and muscular coats of the gut appeared red and inflamed.
  The omentum was so much wasted, that nothing but its
blood-vessels could be perceived.
  The stomach  was inflamed, both on its outside and in-
side. It contained  a quantity of bile of  the same consist-
ence, but  of a blacker colour than that which-was found  in
the gall bladder.   Its villous coat, like that of  the duode-
num was covered with fuzzy and slimy matter.   It more-
over appeared to be distended or swelled. This peculiarity
in the inner coat of the stomach was universal in  all the bo-
dies  that were opened, of persons who died of this disease. 
          BILIOUS YELLOW FEVER OF 1793.        91

  The lungs, instead of being collapsed, were inflated as in
inspiration. They were all oyer full of black or livid spots.
On these spots were to be seen small vesicles or blisters,
like those of an erysipelas or gangrene, containing a yellow
humour.
  The blood-vessels in general seemed empty of blood,
even the vena cava and its branches; but the vena portarum
was full and distended as usual.  The blood seemed col-
lected in the viscera;  for upon  cutting the lungs, or sound
liver or spleen, they bled freely.
   The brain was not opened in this body, but it was not
affected in three others whose brains were examined.
   Dr. Mackittrick, in his inaugural dissertation, published at
Edinburgh in the year 1766," De Febre Indiae Occidentalis,
Maligna Flava," or upon the yellow fever of the West-Indies,
says, that in some of the patients who died of it, he found the
liver sphacelated, the gall bladder full of black bile, and the
veins turgid with black fluid blood. In others he found the
liver no ways enlarged, and its " texture only vitiated."  The
stomach, the duodenum, atnd ilium, were remarkably inflam-
ed in all cases. The pericardium contained a viscid yellow
serum, and a larger quantity than common.  The urinary
bladder was a little inflamed. The  lungs were sound.
   Dr. Hume,  in describing the yellow fever of Jamaica, in-
forms us, that in several dead bodies which he opened,  he
found the liver enlarged and turbid  with bile, and of a pale
yellow colour.  In some he found the stomach and duode-
num inflamed.   In  one case he discovered black spots in
the stomach, of the size of a crown piece. To this account
he adds, " that he had seen some subjects opened, on whose
stomachs no marks of inflammation could  be discovered ;
and yet tlvse had excessive vomiting."
  Dr.  Lind has furnished us with an account of the state
of the  body after death,  in his  short history of the yellow
fever, which prevailed at Cadiz, in  the year 1764.   " The
stomach (he says,) mesentery, and intestines,  were covered
with gangrenous spots ; there were ulcers on the orifice of
the stomach, and the liver and lungs were of a putrid colour
and texture."*
  To these accounts of the morbid appearances of the body
after death from the yellow fever,  I shall only add the ac-
        i
              * Diseases of Warm Climates, p.  12J. 
92
AN  ACCOUNT  OF THE
count of several»."  actions, which was given to the public
in Mr. Brown's Gazette, during the prevalence of this epi-
demic, by Dr. Physick and Dr. Cathrall.
   " Being well assured of the great importance of  dissec-
tions of morbid bodies in the investigation of the nature of
diseases, we have thought it of consequence that some of
those dead of the present prevailing malignant fever should
be examined; and, without enlarging on our observations,
it appears at present sufficient to state the following facts.
   " 1st. That  the brain in all parts has been found  in a
natural condition.
   " 2d. That the viscera of the thorax  are perfectly  sound.
The blood, howeyer, in the heart and veins is fluid, similar,
in its consistence,  to  the blood of persons who have been
hanged, or destroyed by electricity.
   " 3d. That the stomach, and beginning of the duodenum,
are the parts  that  appear most diseased.  In two persons
who died of the disease on the  5th day,  the  villous mem-
brane of the stomach,  especially about its smaller end, was
found  highly  inflamed; and this  inflammation extended
through the pylorus into the duodenum, some way.  The
inflammation here  was exactly  similar to that induced in
the stomach by acrid poisons, as by arsenic, which we have
once had  an opportunity of seeing in  a person  destroyed
by it.
   " The bile in the gall-bladder was quite  of its  natural
colour, though very viscid.
   il In another person  who died on the 8th day of the dis-
ease, several spots of extravasation were discovered between
the membranes, particularly about  the smaller end of the
stomach, the inflammation of which had considerably abat-
ed.  Pus was seen  in  the beginning of the duodenum, and
the villous membrane  at this part was thickened.
   c| In two  other persons,  who died at a more advanced
period of the disease, the stomach appeared spotted in many
places with extravasations, and the inflammation disappear-
ed.  It  contained, as did also the intestines, a black  liquor,
which had been vomited and purged before death.   This
black liquor appears clearly to be an altered secretion from
the liver;  for a fluid in all respects of the same quality was
found in the gall-bladder.   This liquor  was so acrid,  that
it induced considerable inflammation and swelling on  the 
         BILIOUS  YELLOW FEVER  OF  1793.        93

operator's hands, which remained some days.  The villous
membrane of the intestines,  in these last two bodies, was
found inflamed in several places.
  " The liver was of its natural appearance, excepting in
one of the last persons, on the surface of which a very few
distended veins were seen: all the other abdominal viscera
were of a healthy appearance.
  " The external surface of the stomach, as well as of the
intestines, was quite free  from  inflammation;  the  veins
being distended with blood, which appeared through the
transparent peritoneum, gave them a dark colour.
  " The stomach  of those who  died early in the disease
was always contracted; but iii those who died at a  more
advanced period of it, where extravasations appeared,  it was
distended with air.
                                 "P. S. PHYSICK,
                                 "J.  CATHRALL."

   I have before remarked, that these dissections were made
early in the disease, and that Dr.  Annan attended a dissec-
tion of a body at Bush-hill, some time afterwards, in  which
an unusual turgescence appeared  in the vessels of the brain.
   Thus far have I delivered the history of the yellow fever,
as it affected  the human body with sickness and death.  I
shall  now mention  a few of those circumstances of public
and private distress which attended it. I  have  before re-
marked, that the first reports of the existence of this fever
were treated with  neglect or contempt.   A strange apathy
pervaded all classes of people.   While I  bore my share of
reproach for " terrifying our  citizens  with imaginary dan-
ger," I answered it by lamenting " that they were not terri-
fied enough." The publication from  the college of  physi-
cians soon dissipated this indifference and  incredulity. Fear
or terror now sat  upon every countenance.  The disease
appeared in many parts of the town,  remote from the spot
 where it originated ; although, for awhile, in every instance,
 it was easily traced to it. This set the city in motion. The
 streets and roads leading from the city were crowded with
 families flying in every direction for safety to the  country.
 Business began to languish. Water-street, between Market
 and Race-streets, became a desert.  The poor were the first
 victims of the fever.   From the sudden interruption of 
94              AN ACCOUNT OF  THE
business they suffered for a while from poverty as well as
from disease.   A  large and airy house at Bush-hill, about
a mile from the city was opened for their reception.  This
house, after it became the charge of a committee appointed
by the citizens on the 14th of September,  was regulated
and governed with the order and  cleanliness of an old and
established hospital.   An American and French physician
had the exclusive  medical care of it after the 22d of Sep-
tember.
   The disease, after the second week in September, spared
no rank of citizens.   Whole families were confined by  it.
There was a deficiency of nurses for the sick, and many of
those who were employed were unqualified for their busi-
ness.   There was likewise a great deficiency of physicians
from the desertion  of some, and  the sickness and death of
others.   At one time there were  but three physicians who
were able to do business out of their houses,  and at this
time there  were probably not  less  than 6000 persons ill
with the fever.
   During the first  three or four weeks of the prevalence of
the disease I seldom went into a house the first time with-
out meeting the parents or children of the sick in tears.
Many wept aloud in my entry or parlour, who came to ask
for advice for their relations. Grief after a while descended
below  weeping, and I was much  struck in observing that
many persons submitted to the  loss of relations and friends
without shedding a tear, or manifesting any other of the
common signs  of grief.
   A cheerful countenance was  scarcely to be seen in  the
city for six weeks.  I recollect once, in entering the house
of a poor man,  to  have met a child  of two  years old that
smiled in my face.  I was strangely affected with this sight
(so discordant  to  my feelings  and  the state  of the city)
before I recollected the age and ignorance of the child.   I
was confined the next day by an attack of the fever, and
was sorry to  hear,  upon my recovery, that the father and
mother of this little creature died a few days after  my last
visit to them.
   The streets every where discovered marks of the distress
that pervaded the city. More than  one half the houses were
shut up,  although not more than one third of the inhabitants
had fled into the country.  In walking for  many hundred 
BILIOUS YELLOW FEVER OF  1793.
95
yards, few persons were met, except such as were in quest
of a physician, a nurse, a bleeder, or the men who buried
the dead.   The hearse alone kept up die remembrance of
the noise of carriages or carts in the streets.   Funeral pro-
cessions were laid aside.   A black man, leading or driving
a horse, with a corpse on a pair of chair wheels, with now
and then half a  dozen relations or  friends  following  at  a
distance from it, met the eye in most of the streets of  the
city, at every hour of the day,  while the noise of the same
wheels passing slowly over the pavements, kept alive  an-
guish and  fear in the sick and  well, every  hour of  the
night.*
   But a more serious source of the distress of the  city
arose  from  the  dissensions of the  physicians, about  the
nature and  treatment of the fever.   It was considered  by
some  as a modification of the  influenza, and by others as
the jail fever. Its various grades and symptoms were consi-
dered as so  many different diseases,  all  originating from
different causes.  There was the same contrariety in  the
practice of the physicians that  there  was in their principles.
The newspapers conveyed accounts of both to the public,
every day.   The minds  of the citizens were distracted by
them, and hundreds suffered  and   died from  the delays
which were produced by an erroneous opinion of a plurality
of diseases in the city, or by indecision in the choice, or  a
want of confidence in the remedies of their physician.
   The science of medicine is  related  to  every  thing, and
the philosopher as well as the Christian will be gratified by
knowing the effects of  a great and  mortal epidemic upon
the morals of a people.   It was some  alleviation of  the

  * In the life  of Thomas Story, a celebrated preacher amorg the friends,
there is an account of the distress  of the city, in i*s  infant state, from the
prevalence of the yellow fever, in the autumn of 1699, nearly like that which
has been described. I shall  insert the account in his own words.  "  Great was
the fear that fell on all flesh.  I saw no lofty or  airy countenance, nor heard
any vain jesting to move men to  laughter. Every face gathered paleness, and
inuiiv hearts were humbled, and countenances fallen and  sunk, as such that
waited every moment  to be summoned to the bar, and numbered to the grave."
The same author adds, that six, seven, and sometimes eight, died of this fever
in a day, for several weeks.  His fellow traveller, and companion in  the rainis-
tiv, Kuger (Jill, discovered upon  this  occasion an extraordinary  degree of
christian philanthropy. He publicly offered himself in one of the meetings
of the  society, as a  sacrifice for  the  people, and prayed that "God would
pjease to accept of his life for them, that a stop might be put to the contagion."
He  died of the fever a few days af erwards. 
96              AN  ACCOUNT OF  THE
distress produced by it,  to  observe  its influence upon the
obligations of  morality  and religion.  It was remarked
during this time, by many people,  that the name of the
Supreme Being was seldom profaned, either in the streets,
or in the intercourse of the citizens with each other.  But
two robberies, and those of a trifling  nature, occurred in
nearly two months, although many  hundred houses  were
exposed  to  plunder, every hour of the day and night.
Many of the religious societies met two or three times a
week,  and some of them every evening, to implore the
interposition of Heaven  to save the city  from desolation.
Humanity and charity kept pace with devotion.  The pub-
lic have already seen accounts of their benevolent exercises
in other publications.  It was  my lot to  witness  the un-
common activity of those virtues upon a smaller scale.   I
saw little to blame, but much to admire and praise in per-
sons of different professions, both  sexes, and of all colours.
It would be foreign  to  the design  of this work to  draw
from the obscurity which they sought, the many acts of hu-
manity and charity, of fortitude, patience, and perseverance,
which  came under my notice.   They will be made public
and applauded elsewhere.
   But the virtues which were excited by our calamity were
not confined to the city of Philadelphia.  The United States
wept for the distresses  of their capital.   In several of the
states,  and in many cities and villages, days of humiliation
and prayer were set apart to supplicate the Father of  Mer-
cies in behalf of our afflicted city.  Nor was this all. From
nearly every state in the union the most liberal contributions
of money, provisions,  and fuel were poured in  for the
relief and support of such as had been reduced to want
by the suspension of business,  as well as by sickness and
the death of friends.
   The number of deaths between the 1st of August and
the 9th of November amounted to four diousand and forty-
four.   I shall here insert a  register  of the number which
occurred on each day, beginning on the  1st of August, and
ending on the  9th of November.  By comparing it with
the register of the weather it will show the influence of the
latter  on the disease.   Several of the deaths in  August
were from other acute diseases, and a few in the succeeding
months were from such as were ■ of a chronic nature. 
?ILI0US YELLOW FEVER OF 1793.
97
August
September
	died.		died.
1	9	Brought forward	456
2	8	September 8	42
3	9	9	32
4	10	10	29
5	10	11	r23
6	3	12	33
7	12	13	37
8	5	14	48
9	11	15	56
10	6	16	67
11	7	17	81
12	5	18	68
13	11	19	61
14	4	20	67
15	9	21	57 '
16	7	22	76
17	6	23	68
18	5	24	96
19	9	25	87
20	7	26	52
21	8	27	60
22	13	28	51
23	10	29	57
24	17	30	63
25	12	October 1	74
26	17	2	66
27	12	3	78
28	22	4	58
29	24	5	71
30	20	6	76
31	17	7	82
1	17	8	90
2	18	9	102
3	11	10	93
4	23	11	119
5	20	12	111
6	24	13	104
7	18	14	81
456
2972
VOL. III.
N 
98
AN ACCOUNT  OF THE
		died.			died.
Brought forward		2972 Brought forward			3685
October	15	80	October	28	24
	16	70		29	17
	17	80		30	16
	18	59		31	21
	19	65	November	1	13
	20	55		2	21
	21	59		3	15
	22	82		4	15
	23	54		5	14
	24	38		6	11
	25	35		7	15
	26	23		8	8
	27	13		9	6
		3685		Total* 3881	
  From this table it appears that the principal mortality
was in the second week of October.   A  general expecta-
tion had obtained,  that cold weather was as fatal to this
fever as heavy rains.   The usual time for its arrival had
eome, but the weather was still not only moderate, but
warm.  In this awful situation, the stoutest hearts began to
fail.  Hope sickened, and despair succeeded distress in al-
most every countenance.  On the fifteenth of October, it
pleased God to alter the state of the air. The clouds at last
dropped health in showers of rain,  which continued  during
the whole day, and which were succeeded  for several nights
afterwards by cold and frost. The effects of this change in
the weather appeared first in the sudden diminution of the
sick,  for the deaths continued  for a week  afterwards to be
numerous, but they were of persons who had been confin-
ed  before, or on the day in which  the change had taken
place in the weather.
  The appearance of this rain was like a dove with an olive
branch in its mouth to the whole city.  Public notice was
given of its beneficial effects,  in a letter subscribed  by the
mayor of Philadelphia, who acted as president of the com-
  * In the above accounts there is a deficiency of returns from several grave-
yards of 163. 
          BILIOUS YELLOW FEVER OF 1793.         99

mittee, to the mayor of New-York.  I shall insert the whole
of this letter.  It contains,  besides the above information, a
record of the liberality of the city to the distressed inhabi-
tants of Philadelphia.

" Sir,
     "lam favoured with your  letter of the 12th instant,
which I have communicated to the committee for the relief
of the poor and afflicted of this  city.
  "It is with peculiar satisfaction that I execute their  re-
quest, by making  in their name,  on behalf of our suffering
fellow-citizens, the most grateful acknowledgments for  the
seasonable benevolence of the common council of the city
of New-York.  Their sympathy is balm to our wounds.
  " We acknowledge the Divine  interposition, whereby
the hearts of so many around us have been  touched with
our distress,  and have united in our relief.
  " May the Almighty Disposer of all events be graciously
pleased to protect  your citizens from the dreadful calamity
with  which we are now visited; whilst we humbly kiss  the
rod, and improve by the dispensation.
   " The part, sir, which you personally take  in  our  af-
flictions, and which you have  so pathetically expressed in
your letter,  excites in the breasts  of the  committee  the
warmest sensations of fraternal affection.
   " The refreshing rain which fell the day before yesterday,
though light, and the cool weather which hath succeeded,
appear to have given a check to  the prevalence of  the dis-
order : of this  we have satisfactory proofs,  as well in  the
decrease of the funerals, as in  the applications for removal
to the hospital.
  " I have,  at your request, tins day drawn upon  you, at
sight, in favour of the president and directors of the Bank
of North America, for the sum  of five thousand  dollars,
the benevolent donations of the common council of the city
of New-York.
     " With  sentiments of. the  greatest esteem and regard,
                          " I am, sir,
                    " Your most obedient humble servant,
                         "MATTH. CLARKSON.
   •" Pfiiladelp/aa, Oct. 17, 1793.
" Ririunn VimiK, Mayor oC the city of New-Vork " 
100
AN ACCOUNT OF THE
  It is no new thing for bilious fevers, of every description
to be checked or subdued by wet and cold weather.
  The yellow fever which raged  in Philadelphia in 1699,
and which is taken notice of  by Thomas Story in his jour-
nal,  ceased about the latter end of October, or the begin-
ning of November.   Of this there are satisfactory  proofs,
in the register of the interments in the Friends'  burying-
ground, and in a letter dated November 9th, old style, 1699,
from Isaac Norris to one of  his correspondents, which his
grandson, Mr. Joseph P. Norris, politely put into my hands,
with several others, which mention the disease, and all writ-
ten in that memorable year in Philadelphia.  The letter says,
" It has pleased God to put a  stop to our sore visitation,
and  town and country are now generally healthy."  The
same disease was checked by wet and cold weather in the
year 1741.  Of this there is a proof  in  a  letter from Dr.
Franklin to one  of his brothers, who stopped at Burlington,
on his way from Boston to Philadelphia, on account of the
fever,  until he was assured by the Doctor, that a thunder
gust, which had cooled the air, had rendered it safe  for him
to come into the city.*   Mr. Lynford Lardner, in a letter
to one of his  English friends,  dated  September 24,  1747,
old style, after mentioning the prevalence of the fever, in the
city, says, " the  weather is now much cooler, and those un-
der the disorder  revive.  The  symptoms  are less violent,
and the fever gradually abates."
   I have in  vain attempted to procure an account of the
time of the commencement  of cold weather in the autumn
of 1762.  In the short history of the fever of that year,
which I have  inserted from my note book, I have said that
it continued to prevail in the months of November and De-
cember. The register of the interments in the Friends' bu-
rying-ground  in those months confirms that account.  They
were nearly as numerous in November and December as
in September  and October, viz. in September 22, in Octo-
ber 27, in November 19, and in December 26.

  * From a short  note in the register of the interments in the Friends' bury-
mg-ground, it appears that the fever this year made its  first appearance in the
month of June.   The following is a copy of that note: " 12th of the 6th
i^onth (O. S.) 1741,  a malignant yellow fever now spreads much."  Besides
that.note> there is the following: «25th of the 7th month (O. S.) 1741, many
who d'v£ <>f .the above distemper were persons lively, and strong', and in the
prime of ti^ir time."                               &' 
BILIOUS YELLOW FEVER  OF 1793.       101
  The bilious remitting fever of 1780 yielded to cool wea-
ther, accompanied by rain and easterly wind.
  Sir John Pringle will furnish ample satisfaction to such
of my readers as wish for more proofs of the  efficacy  of
heavy rains, and cold weather, in checking die progress and
violence of autumnal remitting fevers.*
  From the 15th of  October the disease not only declined,
but assumed more obvious inflammatory symptoms. It was
as in the beginning,  more necessarily fatal where left to it-
self, but it yielded more certainly to art than it did a few
weeks before.   The duration of  it was now more tedious
than in the warm weather.
  There were a few cases of yellow fever in November and
December, after the citizens who had retired to the country
returned to the city.
  I heard of but three persons who returned to the city be-
ing infected with the disease; so  completely was its cause
destroyed in the course of a few weeks.
   In consequence of a proclamation by the governor,  and
a recommendation by the clergy of Philadelphia, the 12th
of  December  was  observed  as  a  day of thanksgiving
throughout the state, for the extinction of the disease in the
city.
   It was easy to distinguish, in walking the  streets, the
persons  who had returned  from the country  to the  city,
from  those who had remained in  it during the  prevalence
of  the fever.  The  former appeared  ruddy and healthy.
while the latter appeared of a pale sallow colour.
   It afforded a subject of equal surprise and joy to behold
the suddenness  with which  the city recovered its former
habits of business.   In the course of six weeks after the
disease had ceased, nothing but fresh graves, and the black
dresses of many of the citizens, afforded a public  trace of
the distress, which had so lately prevailed in the city.
   The month of November,  and all  the  winter months
 which followed  the  autumnal  epidemic,  were  in general
 healthy. A catarrh affected a number of people in Novem-
 ber.   I suspected it to be the influenza which had revival
 from a dormant state, and which had not spent itself, when
 it  yielded  to the predominance of the yellow fever.  This
 opinion derives some support from a curious fact related b-,
                    • p. 5. J5, 108, and 12X 
102
AN  ACCOUNT OF THE
 the late Mr. Hunter of the revival of the small-pox in a pa-
 tient, in whom it had been suspended for some time by the
 measles.*  The few fevers which prevailed in the wirier
 were highly inflammatory.  The small-pox in the natural
 way was  in several instances confluent; and in one or two
 fatal.  I was prepared to expect this inflammatory diathesis
 in  the  fevers  of the winter; for I had been taught by Dr.
 Sydenham, that the diseases which follow a great and mor-
 tal epidemic partake more or less of its general character.
 But the diseases of  the winter had  a peculiarity still more
 extraordinary ; and that was, many of them had several of
 the symptoms of the yellow fever, particularly a puking of
 bile, dark-coloured stools, and a yellow eye.   Mr. Samuel
 D. Alexander, a student of medicine from  South-Carolina,
 who  was  seized with a pneumony  about Christmas, had,
 with a yellow eye, a dilated pupil and a hard pulse,  which
 beat only  fifty strokes in a minute.  His blood was such as
 I had frequently observed in the yellow fever. Dr. Griffitts
 informed  me that he attended a patient on the 9th of Janu-
 ary, in a pneumony, who had an universal yellowness on his
 skin.  I met with a case of pneumony on the 20th of the
 same month, in which I observed the same degrees of red-
 ness  in die eyes that were common  in the yellow fever.
 My pupil, Mr. Coxe, lost blood in an inflammatory fever,
 on  the 18th of  February, which was dissolved.  Mr. Innes,
 the brewer, had a deep yellow  colour  in his eyes on the
 fourth day of a pneumony, on the 27th of the same month;
 and Mr. Magnus Miller  had the same symptom of a simi-
 lar  disease on  the 16th of March.  None of these bilious
and anomalous symptoms of the inflammatory fevers  of the
 winter and spring surprised me.  I  had been early taught
by  Dr. Sydenham that the epidemics of autumn often in-
 sinuate  some of their symptoms into the  winter diseases
 which follow them.  Dr. Cleghorn  informs us, that " the
pleurisies  which succeeded the autumnal tertians in Minor-
ca,  were accompanied by a vomiting and purging of green
or yellow  bilious matters."!
  It belongs to powerful epidemics to be followed by simi-
lar  diseases after they  disappear,  as well  as to  run  into
others at their first  appearance.   In the former case it  is

 * Introduction to a Treatise on the Venereal nisease, p. 3, of the American
edition.                      f Page 273. 
          BILIOUS YELLOW FEVER OF  1793.        105

occasioned by a peculiar state of the body,  created by the
epidemic  constitution of the air,  not having been  changed
by the weather which succeeded it.
  The weather  in March resembled that of  May ; while
the weather in April  resembled that of March in common
years.   A rash prevailed in many families, in April, ac-
companied in a few cases by a sore throat. It  was  attended
with an itching,  a redness of the eyes, and a slight fever in
a  few instances.  The small-pox by  inoculation in this
month was more mortal than in former years. However un-
important these facts may appear at this time, future ob-
servations may perhaps connect them with a similar consti-
tution of the air which produced the previous autumnal
epidemic.
   The appearance of bilious symptoms  in the diseases of
the winter, excited apprehensions in several instances of the
revival  of the yellow fever.  The  alarms, though  false,
served to produce vigilance and industry in  the corporation,
in airing and purifying such houses and articles of furniture
as belonged to the poor ; and which had  been neglected in
the autumn, after the ceasing of the disease.
   The modes of purifying houses,  beds, and clothes were
various.  Fumigations  of nitre  and aromatic  substances
were used by some people.  Burying infected articles of
furniture  under ground, and baking them in ovens,  were
used by others.  Some destroyed all their beds and clothing
that  had been infected, or threw them into the Delaware.
Many white-washed their walls, and painted the wood-work
of their house.   I did not conceive the seeds of the disease
required all, or any of those means to destroy it. I believed
cold and water to be sufficient for that purpose.  I  therefore
advised keeping the  windows of infected  rooms open night
and  day,  for a few days ;  to have the  floors  and  walls of
houses well washed; and to expose beds and such articles
of household furniture as might be injured by washing, up-
on the bare earth for a week or two,  taking  care to  turn
them every day.  I  used no other methods of destroying
the accumulated miasmata  in my house and furniture, and
experience showed that they were sufficient.
   It is possible a portion of the excretions of the sick may
be retained in clothes or beds, so  as to afford an exhalation
that may in the course of a succeeding summer and autumn, 
104
AN ACCOUNT OF THE
or  from accidental warmth at any time,  create a solitary
case of fever, but it cannot render it epidemic.  A trunk
full of clothes,  the property of Mr. James Bingham, who
died of the yellow fever in one of the West-India Islands,
about 50 years ago, were opened,  some months after they
were received by his friends, by a young man who lived in
his brother's family.  This young man took the disease,
and died; but without infecting any of the family; nor did
the disease spread afterwards in the  city.  The father of
Mr. Joseph Paschall was infected with  the yellow fever of
1741,  by the smell of a foul bed in passing through Nor-
ris's Alley, in the latter end of December, after the disease
had left the city.   He died on the 25th of the month,  but
without reviving the fever in the city, or even infecting his
family.
  The matter which produced the fever in both these cases,
had nothing specific in it.  It acted in the same manner that
the exhalation from any other putrid matters would have
done in a highly concentrated state.
  In  a letter from Dr. Senter of Newport, dated January
7th, 1794,  I find the  following fact, which I shall commu-
nicate  in his own  words.  It is  introduced to support the
principle, that the yellow fever does not spread by  conta-
gion.   " This place (says the doctor) has traded formerly
very much to the West-India Islands,  and more or less of
our people have died there every season,  when the disease
prevails in those parts.   Clothes of these unfortunate peo-
ple have been  repeatedly  brought home to their friends,
without any accident happening to them."
  I feel with my reader  the fatigue  of this long detail of
facts, and equal impatience with him to proceed to the his-
tory of the treatment of the fever; but I must beg leave to
detain  him a little longer from that part of the work, while
I resume the subject of the origin of the fever. It is an in-
teresting question, as it involves in it the means of prevent-
ing the return of the disease, and thereby of saving the lives
of thousands of our citizens.
  Soon after the fever left the city, the governor of the state
addressed a letter to the college of physicians, requesting to
know  their  opinion of its origin; if imported, from what
place,  at what time, and in what manner.  The design of
this inquiry was to procure such information as was proper
to  lay before the legislature, in order to improve the laws 
         BILIOUS  YELLOW FEVER OF  1793.       105

ibr preventing the importation or  generation of infectious
diseases, or to enact new ones, if necessary for that purpose.
To the governor's letter the college of physicians  sent the
following answer:

"Sir,
       " It  has not been from a want of respect  to your-
self,  nor from inattention to the subject, that your  letter of
the 30th ult.  was not sooner answered;  but the importance
of the questions proposed has made it  necessary for us to
devote a considerable portion of time and  attention to the
subject, in order to arrive at a safe and just conclusion.
   " No instance has ever occurred of the disease called the
yellow fever having been generated  in  this city, or in any
other parts of the United States, as  far as we know; but
there have been frequent instances of its  having been im-
ported, not only into this,  but  into other parts of North
America, and prevailing there for  a certain period  of time;
and from the rise, progress, and nature of the malignant fever,
which began to prevail here about  the beginning of last
August, and extended itself gradually over a great part of
the city, we are of opinion that this  disease was imported
into Philadelphia, by some of the  vessels which arrived in
the port after the middle of July.  This opinion we are fur-
ther confirmed  in  by various accounts we have  received
from unquestionable authorities.

           " Signed,  by order of the college of physicians,
                       " JOHN  REDMAN,  President.

" November 26th,  1793.-
   "  To the governor  of Pennsylvania.''''

   Dr. Redman, the president  of the college, Dr. Foulke,
and Dr. Leib,  dissented from the report  contained in this
letter.  I have been  necessarily led to continue  it in the
present  edition of this work, not only because all the other
members of  that body still  retain dieir belief of the impor-
tation of the  fever, but as a reason  for republishing the facts
and arguments in support of its domestic origin.
   I have asserted, in the introduction to the history of thi^
vol. hi.
9 
106
AN ACCOUNT  OF  THE
  fever, that I believed it to have been generated in our city;
  I shall now deliver my reasons for that belief.
     1. The yellow fever in the West-Indies, and in all other
  countries where it is endemic, is the offspring of vegetable
  putrefaction.  Heat, exercise, and intemperance in drinking
  (says Dr.  Lind) dispose to this fever in hot climates, but
  they do not produce it without the concurrence of a remote
  cause. This remote cause exists at all times, in some spots
  of the islands, but in other parts even of the same islands,
  where  there are no  marsh exhalations, the disease is un-
  known.   I shall not waste a moment in inquiring into the
  truth of  Dr.  Warren's account of the origin of this fever.
  It is fully refuted by Dr. Hillary, and it is treated as chime-
  rical by Dr.  Lind.   They have very limited ideas of the
  history of this fever, who suppose  it  to  be peculiar to the
  East or West-Indies.   It was admitted to have been gene-
  rated in Cadiz after a hot and dry summer in 1764, and in
  Pensacola in  1765.*  The tertian fever of Minorca, when
  it attacked Englishmen, put on the usual symptoms of the
  yellow fever, f In short, this disease appears, according to
  Dr. Lind, in  all the southern  parts of Europe, after hot and
  dry weather .J
    2. The  same  causes (under like  circumstances) must
  always produce the same effects.   There is nothing in the
  air of the West-Indies, above other  hot  countries, which
  disposes  it to produce a yellow fever.  Similar degrees of
  heat, acting upon dead and  moist vegetable matters, are
  capable of producing it, together with all its various modi-
  fications, in every part of the world.  In  support of this
  opinion, I shall transcribe part of a letter from Dr.  Miller,
  formerly  of the Delaware state, and now of New-York.

                                    Dover, Nov. 5, 1793.
  "Dear  Sir,
                " SINCE the  middle  of last July we have
  had a bilious  colic epidemic in  this neighbourhood, which
  emibits phenomena very singular in this climate ; and, so
  fif hs J am informed, unprecedented in the medical records,
i-  0r popular  traditions of this country.  To avoid unneces-
  sary details it will suffice  at  present  to observe, that the
   * Lind on the niseases of Hot Climates, p. 36 and 124.
   fOleghorn, p. 176.          $ Diseases of Hot Climates, p. 1?3 
BILIOUS YELLOW FEVER OF  1793.
107
disease, on this occasion, has assumed not  only  all the
essential characters, but likewise all the violence, obstinacy
and  malignity described  by the Ea6t  and West Indian
practitioners.  If any difference can be observed, it seems
here to  manifest higher degrees of stubbornness and ma-
lignity than we usually meet in the histories of tropical wri-
ters. In the course of the disease, not only extreme consti-
pation, frequent vomiting, and the most  excruciating pains
of the bowels and limbs,  harass the  unhappy  patient;  but
to these succeeded paralysis, convulsions, &c.; and almost
always uncommon  muscular  debility,  oppression of the
praecordia,  &c. are  the  consequence of a severe attack.
Bile discharged in enormous quantities constantly assumes
the most corrupted  and acrimonious  appearances, com-
monly aeruginous in a very high degree, and  sometimes
quite atrabilious.
   " The inference I  mean to draw from the phenomena of
this disease, as it appears in this neighbourhood, and which
I presume will  also apply to your epidemic, is this,  that
from the uncommon  protraction  and intenseness of our
summer and autumnal heats, but principally from the un-
usual drought,  we have had, since  the  middle of July, a
near approach to a tropical season, and that of consequence
we ought not to be surprised if tropical diseases, even of
the most malignant nature, are engendered amongst us."
   To  the  above information it may be  added, that the
dysentery which prevailed during the autumn of 1793, in
several of the villages  of Pennsylvania,  was attended with
a malignity and mortality unknown before in any part of
the state.   I need not pause to remark that this dysentery
arose from putrid exhalation, and that it is, like the bilious
colic, only a modification of bilious fever.
   But further, a malignant  fever, resembling that which
was epidemic in our city, prevailed during the  autumn in
many parts of the United States, viz. at Lynn in Massa-
chusetts, at Weatherfield and Coventry in Connecticut, at
New-Galloway in the state of New-York,  on  Walkill, and
on Pensocken creeks  in New-Jersey, at  Harrisburg  and
Hummelstown  in  Pennsylvania,  in  Caroline county in
Maryland, on the south branch of the Potowmac in Hardie
county, also in Lynchburgh and in Alexandria in Virginia,
and  in  several  counties  in  North-Carolina.   In none of 
loa
AN ACCOUNT OF THE
 these  places  was there a suspicion of the disease  being
 imported from abroad, or conveyed by an intercourse with
 the city of Philadelphia.
   It is no objection to the inference which follows  from
 these facts, that the common remitting fever was not known
 during the above period in the neighbourhood of this city,
 and in many other parts of the state, where  it had usually
 appeared in the autumnal months.  There is a certain com-
 bination of moisture  with heat,  which  is essential to the
 production of the remote cause of a bilious fever.  Where
 the heat is so intense, or of such long duration, as wholly
 to dissipate moisture, or when the  rains are so great as to-
 tally  to overflow the marshy ground,  or to wash  away
 putrid masses of matter,  no fever  can be produced.
   Dr. Dazilles,  in his treatise upon the diseases of the ne-
 groes in the West-Indies, informs  us, that the rainy season
 is the most healthy at Cayenne, owing to the neighbouring
 morasses being deeply overflowed ;  whereas,  at St. Domin-
 go, a dry season  is most productive of diseases, owing to
 its  favouring  those degrees of  moisture which  produce
 morbid  exhalations.   These  facts  will explain the reason
 why,  in certain seasons,  places which are naturally healthy
 in our country become sickly, while those places which are
 naturally sickly escape the prevailing epidemic.  Previously
 to the dissipation of  the  moisture  from the putrid masses
 of vegetable matters in other streets, and in the neighbour-
 hood  of the city, there were (as  several  practitioners can
 testify)  many cases of mild remittents,  but  they all disap-
 peared about the  first week in September.
  It is worthy of notice, that the yellow fever  prevailed in
 Virginia in the  year  1741, and in Charleston,  in South-
 Carolina, in the year 1699, in both which years it prevailed
 in Philadelphia.  Its  prevalence in Charleston is taken
 notice of in a letter,  dated November 18th, O. S. 1699,
 from Isaac Norris to one of his correspondents. The  letter
 says that " 150 persons had died  in  Charleston in a few
days," that " the survivors fled into the country,"  and that
 " the  town was thinned to a  very   few people." It is not
probable, from the prevalence  of this fever  twice in  two
places in the same years, that it was produced (as in 1793)
by a general constitution  of air,  co-operating with mias-
mata, which favoured  its generation in  different parts of the 
         BILIOUS  YELLOW FEVER OF  1793.      109

continent?  But again, such was the state of the air, in the
summer of 1793, that it predisposed other animals to dis-
eases, besides the human species.  In some parts of New-
Jersey, a disease  prevailed with great mortality among the
horses, and in Virginia among the cows, during the autumn.
The urine in both was yellow.—Large abscesses appeared
in different parts of the  body in the  latter animals, which,
when opened,  discharged a yellow  serous fluid.  From
the colour of these  discharges, and of the urine, the disease
got the name of the yellow water.
   3.  I have before  remarked, that a quantity of damaged
coffee was exposed  at a  time (July the 24th) and in a situ-
ation  (on a  wharf  and in a dock) which favoured its  pu-
trefaction and exhalation.   Its smell was highly putrid and
offensive, insomuch that  the inhabitants  of the houses in
Water and Front-streets,  who were near it, were  obliged,
in the hottest weather, to exclude it by shutting their doors
and windows.  Even persons who only walked along those
streets complained of an intolerable foetor, which, upon in-
quiring, was constantly traced to the putrid coffee. It should
not surprise us, that this seed, so inoffensive in its  natural
state, should produce, after its putrefaction, a violent fever.
The records of medicine  (to be mentioned hereafter) fur-
nish  instances  of similar fevers  being produced by  the
putrefaction of many other vegetable substances.
   4.  The  rapid  progress of the  fever from Water-street,
and the courses through  which it travelled into other parts of
the city, afford  a  strong evidence that it was at first propa-
gated by exhalation from the putrid coffee.  It was observ-
ed  that it  passed  first  through those alleys   and streets
which were in the course of the winds that blew across the
dock  and wharf,  where the  coffee had been   thrown in a
state of putrefaction.
   5.  Many persons who had worked, or even visited, in
the neighbourhood of the exhalation from the coffee, early
in the month of August, were indisposed afterwards with
sickness, puking, and yellow sweats, long before the air of
Water-street was so much impregnated with the exhalation,
as to produce such  effects; and  several patients,  whom I
attended in the  yellow fever,  declared to  me,  or  to their
friends, that  their indispositions began exactly at the time
they inhaled the offensive effluvia of the coffee. 
 HO             AN  ACCOUNT OF THE

   6.  The first cases of the yellow fever have been clearly
 traced to the sailors of the vessel who were first exposed to
 the effluvia of the  coffee.  Their sickness  commenced
 with the day on which the coffee began  to emit its putrid
 smell. The disease spread with the increase of the poison-
 ous exhalation.   A journeyman of Mr. Peter Brown, who
 worked near the corner of Race and Water-streets,  caught
 the disease on the 27th of July. Elizabeth Hill,  the wife
 of a fisherman, was infected by only sailing near the pesti-
 lential wharf, about the 1st of August, and died  at Ken-
 sington on  the 14th of  the same month.  Many other
 names might be mentioned of persons who sickened dur-
 ing the last week in July or the first week in  August, who
 ascribed their illness to the smell of the coffee.
   7.  It has been remarked that this fever did not  spread in
 the country, when carried there by persons  who were in-
 fected, and  who afterwards died  with  it.   During four
 times in which it prevailed in Charleston, in no one instance,
 according to Dr. Lining, was it propagated in any other
 part of the state.
   8.  In the histories of the disease which have been pre-
 served in this country, it has six times appeared about the
 first or middle of August, and  declined or ceased  about
 the middle  of October:  viz.  in  1732, 1739, 1745, and
 1748  in Charleston, in 1791 in New-York, and in 1793 in
 Philadelphia.   This frequent  occurrence of the  yellow
 fever  at the usual period of our common bilious remittents,
 cannot be ascribed to accidental coincidence, but must be
 resolved, in most cases, into the combination of more active
 miasmata with the predisposition of a  tropical season.  In
 speaking of a tropical season, I include  that  kind of wea-
 ther in which rains and heats are alternated with each other,
 as well as that which is uniformly warm.
   9.  Several circumstances attended this epidemic, which
do not occur in the West-India yellow  fever.  It affected
children as  well  as adults, in common  with  our annual
bilious fevers.  In the West-Indies, Dr.  Hume tells us, it
never attacked any person under puberty.  It had more-
over, many peculiar symptoms (as I have already  shown)
which are not to be met with in any of the histories of the
 West-India yellow fever.
   10. Why should  it surprise us to  see a  yellow fever 
BILIOUS YELLOW FEVER OF 1793.        Ill
  generated amongst us? It is only a higher grade of a fever
  which prevails every year in our city, from vegetable pu-
  trefaction.   It conforms, in the difference of its degrees of
  violence and danger to season as well as climate, and in this
  respect it is  upon a footing with the small-pox, the measles,
  the sore throat, and several  odier diseases.  There are few
  years pass, in which a plethoric habit, and more active but
  limited  miasmata, do  not produce sporadic cases of true
  yellow fever in Philadelphia.  It is very  common  in South
  and North-Carolina and in  Virginia,  and  there are facts
  which prove, that not only strangers, but  native individuals,
  and in one instance,  a whole family, have been carried off
  by it in the state of Maryland.   It proved fatal to one hun-
,  dred persons in the city of New-York, in the year  of 1791,
  where it was evidently generated  by   putrid exhalation.
  The yellow colour of  the skin has unfortunately too often
  been considered  as the characteristic  mark of this fever,
  otherwise many other instances of its prevalence might be
  discovered, I have no doubt,  in every part of the United
  States.   I wish, with Dr. Mosely, the term yellow could
  be abolished from the titles of this fever, for this  colour is
  not only frequently absent, but sometimes occurs in the
  mildest bilious; remittents.   Dr. Haller,  in his pathology,
  describes an epidemic of this kind in Switzerland,  in which
  this colour generally attended,  and I have once seen it al-
  most universal in a common bilious fever, which prevailed
  in the American army, in the year 1776.
     I cannot help taking notice,  in this place, of an  omission
  in  the answer  to  the governor's letter,  by the college  of
  physicians.  The governor requested to know whether it
  was imported ; if it were, from what place, at what time,
  and in what manner.   In the answer of the  college of phy-
  sicians to  the governor's letter  no notice was taken of any
  of those questions.  In vain did Dr. Foulke call upon the
  college to be more definite in their answer to them.  They
  had faithfully sought for the  information required, but to no
    Sirpose.  The character of their  departed brother,  Dr.
    utchinson, for capacity and vigilance in his office, as in-
  spector  of  sickly vessels, was  urged without effect as an
  argument against the probability of the disease being im-
  ported.  Public report had derived it from several  different
  islands; had chased it from ship to ship,  and from  shore to 
112              AN ACCOUNT  OF THE
shore, and finally conveyed it at different times into the city,
alternately by dead and living bodies; and from these tales,
all of which when investigated, were  proved to be without
foundation, the college of physicians composed their letter.
It would seem, from this conduct of the college,  as if me-
dical superstition had cnanged  its names, and that, in ac-
counting for the origin of pestilential fevers, celestial, plane-
tary, and demoniacal influence had only yielded to the  term
importation.
  Let  not the  reader reject the opinion I  have delivered,
because  it is opposed by so great a majority of the physi-
cians of Philadelphia.   A single physician  supported  an
opinion of the existence of the plague  at Messina, in the
year 1743, in opposition to all  the physicians (33 in num-
ber) of that city.  They denied the disease in question to
exist, because it was not accompanied by glandular swell-
ingSr   Time showed that they were  all mistaken,  and the
plague, which  might probably have been  checked, at  its
first appearance, by their united efforts, was, by means of
their ignorance,  introduced with great mortality  into every
part of the city. This disposition of physicians to limit the
symptoms of several other diseases, cannot be sufficiently
lamented.  The frequent absence of a yellow colour in this
epidemic, led to mistakes  which cost the city of Philadel-
phia several hundred lives.
  The letter of the college of physicians has  served to con-
firm me in opinion,  that  the  plagues  which occasionally
desolated most of the countries of Europe, in former cen-
turies, and which were always  said to be of foreign extrac-
tion, were of domestic origin.   Between the years 1006 and
1680,  the plague was  epidemic fifty-two  times  all  over
Europe.  It prevailed fourteen times in the 14th  century.
The state  of Europe in this  long  period  is well  known.
Idleness, a deficiency of vegetable aliment, a  camp life,
from the frequency of  wars, famine, an uncultivated and
marshy soil, small cabins, and the want of cleanliness in
dress, diet, and furniture, all concurred to generate pestilen-
tial diseases.   The  plagues  which prevailed in London,
every year from 1593 to 1611, and from 1636 to  1649, I
believe were generated in that city.    The  diminution of
plagues in Europe, more especially in London,  appears to
have been produced by the great change in the diet and 
         BILIOUS YELLOW  FEVER OF 1793.       113

manners of the people; also by the more commodious and
airy  forms of the houses of the poor,  among whom the
plague always makes its first appearance.  It is true, these
plagues, were said by authors to have been imported, either
directly or indirectly, from the Levant;  but die proofs of
such importation were as vague and deficient as they were
of the West-India origin of our epidemic.  The pestilential
fevers which have been mentioned, have been described by
authors by the generic name of the plague,  but they appear
to have originated  from putrid vegetable exhalations,  and
to have resembled, in most of their symptoms, the West-
India and North American yellow fever.
  I shall resume this interesting subject in another place,
in which I shall mention a number of additional facts,  not
only in support of the domestic origin of the bilious yellow
fever,  but of its not spreading by contagion, and of course
of its  being impossible to import it.   I shall at the same
time enumerate all its different sources,  and point  out the
means of destroying or removing them,  and thus of exter-
minating the disease from our country.
   With these  observations I  conclude  the history of the
epidemic fever of the year 1793.   A few of its symptoms
which have  been omitted in this history, will be included
in the method of cure, for they were discovered or pro-
duced by the remedies which were given for that purpose.
VOL. III.
p 
 
& The following page begins an account of the states
  of the thermometer and weather, from the 1st of Janu-
  ary to the 1st of August, and of the states of the ba-
  rometer, thermometer, winds, and weather, from the
  1st of August to the 9th of November, 1793.   The
  times of observation, for the first three months, are at
  7 in the morning, and 2 in the afternoon; for the  next
  five months they are at 6 in the morning, and 3 in the
  afternoon.  From the 1st of October to the 9th of No-
  vember, they are as in the first three months^ 
 
THE BILIOUS  YELLOW FBVER OF  1793.      117
January, 1793.
February, 1793.
  1
  2
  3
  4
  5
  6
  7
  8
  9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
l'hei
7h2h
Weather.
30 Cloudy.
41 Fair, cloudy.
33 Cloudy, rain.
41 Rain, cloudy.
42 Fair, cloudy.
47 Cloudy, fair.
51 Fair, fair.
49 Fair, ditto.
48 Hazy, fair.
51 Fair, ditto.
48 Fair, clouds.
42 Fair, ditto.
42 Fair, ditto.
27 Hail, snow, sleet.
37 Clouds, mist.
39 Rain, ditto.
45 Rain, snow, fair.
52 Fair, ditto.
48 Fair, ditto.
47 Hazy, cloudy,
47 Cloudy, fair,
52 Fair, ditto.
37 Fair, ditto.
39 Cloudy, ditto.
41 Fair, hazy.
   Fair.
38 Fair, cloudy, snow
45 Cloudy, fairr
37 Fair, ditto.
23 Snow, hail.
32[Cloudy,  fair.
W<
7h2h
Weather
Fair, hazy.
Rain, ditto.
Cloudy, fair.
Cloudy, fair.
Cloudy, ditto.
Cloudy, rain.
Cloudy, fair.
Cloudy, ditto.
Rain, fair.
Cloudy, fair.
Fair, cloudy.
Snow, cloudy.
Cloudy, snow.
Cloudy, fair.
Fair, ditto.
Cloudy, ditto.
Rain, ditto.
Cloudy, fair.
Cloudy, rain.
Rain, fair.
Fair, ditto.
Fair, ditto.
Snow, cloudy.
Rain, cloudy.
Cloudy, ditto.
Rain, mist.
Rain, cloudy.
Fair, ditto. 
118               AN ACCOUNT  OF  THE
March, 1793.
April,  1793.
Ther
7h2h
 1
 2
 3
 4
 5
 6
 7
 8
 9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
  20
  31
  48
  43
  51
  32
  36
  54
  26
  29
  43
  40
  38
  26
  3
  52
  51
  58
  53
  42
  41
  31
  35
  37
  35
  47
  43
  33
  34
  41
31142
Weather.
Ther
7h2h
Weather.
   Fair, ditto.         45 70
51 Hazy, cloudy.      4771
63 Rain, fair.          56 80
61 Hazy, ditto.        51 72
52 Rain, fair.          53 61
50 Fair, ditto.         60 76
62 Fair, ditto, clouds.  51 65
60 Cloudy, rain.       46 74
41 Fair, ditto.         55 71
51 Fair, ditto.         50 56
55 Rain, ditto.        37 63
43 Cloudy, ditto.      54 62
39 Cloudy, fair.       49 62
44 Fair, ditto.         50 TO
 9 Fair, ditto.         45 55
62 Cloudy, fair.       46 62
72 Cloudy, fair.       48 67
u9 Hazy, cloudy.      52 66
59 Fair, ditto.         52 75
61 Fair, ditto.         5249
43 Rain, cloudy.      44 47
47 Fair, ditto.         43 46
57 Fair, ditto.         42 68
50 Fair, ditto.         44 68
59 Fair, ditto.         45 65
54 Cloudy, rain.      53 57
51 Fair, cloudy.       4746
45 Fair, clouds, fair.   44 54
57 Fair, ditto.         40 59
58 Cloudy, fair.       40 65
61 Cloudy, fair.
Cloudy, fair.
Fair, ditto.
Fair, ditto.
Cloudy, fair.
Cloudy, rain.
Misty, fair.
Fair, ditto.
Fair, ditto.
Fair, cloudy.
Fair, ditto.
Fair, ditto.
Cloudy, rain, fair.
Fair, ditto.
Fair, ditto.
Rain, cloudy.
Cloudy, fair.
Fair, clouds, fair.
Cloudy, fair.
Fair, ditto.
Rain, cloudy.
Cloudy, ditto.
Rain, cloudy.
Fair, ditto.
Fair, ditto.
Cloudy, ditto.
Cloudy, rain.
Rain, ditto.
Rain, cloudy.
Fair, ditto.
Fair, ditto. 
BILIOUS  YELLOW  FEVER  OF  1793.
119
May, 1793.
June, 1793.
Ther
1).
7h 2h
 9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
2?
28
29
30
31
Weather.
45 69 Foggy, cloudy.
52 73 Fog, clouds, fair.
60 63 Rain, ditto.
60 80 Fair, ditto.
55 56 Cloudy, ditto.
47 58 Cloudy, fair.
50 68 Cloudy, fair.
59 78 Cloudy, fair.
61 79 Foggy, fair.
65 71 Rain, hazy.
55 75 Cloudy, fair.
61 76 Cloudy, rain.
57 78 Fair, ditto.
59 83 Fair, cloudy.
60 71 Fair, ditto.
50 69 Fair, ditto.
48 74 Fair, ditto.
61 81 Cloudy, fair.
65 85 Fair, rain.
65 87 Fair, ditto.
68 86 Fair, ditto, clouds.
 2 80 Clouds, gusts.
94 79 Cloudy, fair.
58 75 Fair, ditto.
5270 Fair, cloudy.
61 66 Rain, ditto.
68 84 Cloudy, fair.
70 68 Fair, clouds, rain.
57 62 Cloudy, rain, clouds
54 57 Cloudy, rain.
54 60 Clouds, ditto.
Ther
7h2l
Weather.
53 61 Rain, showery.
54 64 Clouds, showers.
55 62 Cloudy, rain, fair.
54 60 Rain, do. cloudy.
58 72 Cloudy, fair, rain.
      Cloudy, rain.
68 78 Fair, ditto.
65 — Fair, ditto.
70 88 Fog, fair.
74 90 Fair, ditto.
76 9( Fair, ditto.
75 88 Fair, showers.
74 81 Cloudy, rain.
63 77 Fair, ditto.
63 82 Fair, hazy.
67 85 Fair, ditto.
74 89 Fair, showers.
73 88 Fair, ditto.
77 91 Fair, ditto.
79 88 Fair, rain, fair.
75 85 Cloudy, rain.
58 78 Cloudy, fair.
58 78 Fair, ditto.
60 79 Fair, ditto.
67 74 Cloudy, rain.
66 69 Cloudy, rain.
68 80 Cloudy, fair.
71 85 Cloudy, fair.
77 88 Cloudy, ditto.
74 90 Fair, ditto. 
|20           AN ACCOUNT OF THE
JULY, 1793.
	Barom.				Ther. | vV			inds.	vVeather.
GO	§		&		£	£	£	S	
^1 *			c£		<	Ck	<	h	
	to		CO		-O	CO	CO	°?	
1	30	0	29	9	77	88	VV	w	Fair.
2	29	8	29	7	77	81	w		Fair, showers.
3	22	9	30	0	74	80	E	E	Cloudy.
4	30	1	30	0	70	83	E	SW	Cloudy, fair, rain.
5	30	0	29	9	76	90	NW	SW	Fair, ditto.
6	29	9	29	9	78	91	sw	SW	Cloudy, thunder.
7	29	9	30	0	73	88	NE	NW	Fair, clouds.
8	30	1	30	1	72	85	E	E	Cloudy, fair.
9	30	0	29	8	7S	81	3	SW	Cloudy, ditto.
10	30	0	SO	0	70	84	W	NW	Fair, ditto.
11	30	0	30	0	74	88	NW	NW	Fair, clouds.
12	30	1	30	2	70	84	N	N	Fair, ditto.
13	30	1	30	0	68	83	NW	NW	Fair, ditto.
14	30	0	30	0	65	80	N	Calm	Fair, hazy.
15	30	0	29	s	66	75	SW	SW	Cloudy, ditto.
16	29	8	29	7	70	83	w	w	ilain, fair.
17	29	8	29	9	68	81	NW	NW	Fair, ditto.
18	30	0	30	0	66	86	w	SW	Fair, ditto.
19	29	9	29	9	75	85	SW	w	Fair, cloudy, rain.
20	30	0	30	C	72	87	w	NW	Fair, ditto, sliower.
21	30	1	30	1	70	86	NW	NW	Fair, ditto.
22	30	0	30	0	72	87	SW	SW	Fair, ditto.
23	30	0	30	0	73	91	SW	SW	Fair, cloudy.
24	29	9	29	9	75	89	Calm	w	Cloudy, fair.
25	30	1	30	1	71	83	NW	NNW	Fair, ditto.
26	30	2	30	2	63	82	N	NE	Fair, ditto.
27	30	2	30	1	64	81	S Calm	S	Fair, cloudy.
|2c	5 30	1	30	C	72	85	Calm	NNE	Cloudy, fair.
|2<	)30	1	30	1	74	85	SSE	NE	Cloudv, ditto, rain.
|30l30		1	30	c	73	86	S	SW	Cloudy, fair.
|31|29		9	29	s	76	8C	SSAV	SW	Cloudy, rain. fair.
 
— OtOGC^»OtJi4^03tO*-CtOOO-N|C—! Ui A U JO "" 3 !D (» N CI (.■ X. U s', u		Days.		
03 00 03 03 03 03 03 03 03 03 03 OS 03 03 03 03 03 03 03 03 03 tO tO 03 03 03 03 tO 03 03 {O CCOOOOOOOOOCOCOCOOOOCtOtOOOOOtOOCtO	6			
— i-i to ►— i-1 to to OH.o>tOtO(Jn--Oi«Cj)H-MMh-OOtflOOtOOOfiOK)Oi^O)wtji		A.	M.	P9
03030303 03 030303 03 0303030303 03 0303»OC303C3tOt0tO03O3C303tO0303 OOOOOOOOOOOOOOOOOtOOOOtOtOtOOOOOtOOO	3	p.	M.	o 3
»-►— mU(Qm tO *^ to tO ©"OtCJitOtO — *- Cji O. 0>|BOMC,>-'HUiCC50tOO'Oi".Oi-'0<Jt-< o				
4^iMO"s(OitD>-WUWK)lOK)W^'OtOOiP'OONt»i(OOONWO<K)WO«	6	A.	M.	H
OOOOOSOOSOlOlOOOOOOOOOOOOOOOOOOSOOOOOOCCOOOeooaDOOtOOOOOOON ANCiO»(fi0i'-0i01M»l0(00>Wtnl0t0NlM0O'(TMNONKIwN	3	p.	M.	re
	6	A.	M.	3?
^^^|-KP3BSL ^22 ^k«^ aS^ft^ <<%<-$	3	p.	M.	c V.
» 2. o o" 5" 5" » 5- * » * * M » S 2 2.2. 2. 2. o" 2. o" 2. 2. o" 2.2.2. 2. o" F" g.g.g.g.fg,-" ^^ --1 >?* *-" ? r ~" *-- gJ -" g* J -- <? & ** >* V* \» V, V* V* *• ^*	6	A.	M.	< re p c-f P" re 1
2. 2. 2. «T 0" 0" ? * 2. 2 *" 2 S" 2.2.2. 3" ^ 2. 2. 5" 2.2. 2.2. 2. 2.2. 2. 2.2. "J "» -j pi c c s' t" n" -,' n' c n* -;' t" e h' t" t" c t t ss "i -i i "l "J ■-: "» ». C u. to *• C- G- G-	3	p.	• M.	
 
122
AN ACCOUNT OF THE
SEPTEMBER, 1793.
1 Barom. j Ther.					Winds.		Weather.		
en	S	* * *		£	8	£	s	£	
a	<	&	-i	h	<	pI	<	c£	
	to	co	to	CO	to	CO	to	co	
i	30 0	29 30	71	86	Calm	SW	Fog,	Fair,	
2	29 75	29 8	73	86	SW	SWr	Fair,	Fair,	
3	30 0		60		NW	N	Fair,	Fair,	
4	30 15	30 15	55	75	W	w	Fair,	Fair,	
5	30 15	30 1	62	80	RE	s	Fair,	Cloudy,	
6	29 97	29 95	70	89	WSW	w	Fair,	Cloudy,	
7	30 0	30 0	65	77	WNW	NW	Fair,	Fair,	
8	30 1	30 1	64	70	Calm	Calm	Cloudy,	Cloudy,	
9	30 0	30 0	66	80	SE	NW	Rain,	Fair,	
10	30 0	30 0	64	72	N	NNE	Fair,	Cloudy,	
11	30 1	30 0	62	72	NNE	N	Cloudy,	Fair,	
12	29 96	29 9	58	76	NW	NNW	Fair,	Fair,	
13	29 95	30 0	57	72	NW	N	Fair,	Fair,	
14	30 0	30 5	58	79	NW	NW	Fair,	Fair,	
15	30 0	29 97	65	80	N	S	Fair,	Fair,	
16	29 9	29	70	84	S	SW	Cloudy,	Fair,	
17	29 8	29 85	66	67	N	N	Cloudy,	Cloudy,	
18	30 3		44		N		Fair,		
19	30 4	30 35	45	70	Calm	SW	Fair,	Fair,	
20	30 3	30 15	54	69	Calm	SE	Hazy,	Hazy,	
21	30 0	29 0	59	78	Calm		Cloudy,	Fair,	
22	30 0	30 0	63	83	Calm		Cloudy,	Fair,	
23	30 1	30 1	62	—	Calm	SE	Cloudy,	Cloudy,	
24	30 2	30 2	65	70	NE	ENE	Cloudy,	Fair,	
25	30 15	30 0	61	68	NE	NE	Cloudy,	Cloudy,	
26	29 8	29 7	58	79	N	■N	Cloudy,	Fair,	
27	20 7		64		NW	NW	Cloudy,	Fair,	
28	30 5	30 15	54	73	NW	NW	Fair,	Fair,	
29	30 3	30 3	56	74	NE	ENE	Cloudy, ^ojjgy,	Fair,	
30 30 35		30 3157		75	3alm	SW /]		Fair,	
 
BILIOUS YELLOW FEVER OF 1793.      123
OCTOBER,  1793.
	Barom.			Ther.		VV inds.		Weather.	
00 >->	£		£	£	£	8	S	£	£
Q	<		^	<	£	b	cC	<	h
	|s		(N	^	O)	K.	0?	K	O*
1	30	15	30 5	64	80	SW	SW	Cloudy,	Fair,
2	29	9	30 9	70	72	W	NNW	Cloudy,	Fair,
3	30	2	30 15	50	72	w	SW	Fair,	Fair,
4	29	75	29 7	59	72	SW	w	Cloudy,	Cloudy,
5	30	0	30 1	58	66	N	N	Fair,	Fair,
6	30	3	30 3	43	66	NE	W	Fair,	Fair,
7	30 45			46		Calm		Fair,	
8	30	6	30 6	53	68	N	N	Fair,	Fair,
9	30	5	30 4	53	70	NW	NW	Fair,	Fair,
10	30	2	30 2	49	74	E	NW	Fair,	Fair,
11	30	0	29 85	51	74	W	W	Fair,	Fair,
12	29	6	29 55	58	64	SW	NW	Rain,	Rain,
13	29	85	29 9	49	69	NW	NW	Fair,	Fair,
14'39		5	30 0	52	76	SW	SW	Calm,	Fair,
15	29	75	29 8	56	54	SW	N	Fair,	Rain,
16	30	9	30 0	37	53	NNW	N	Fair,	Fair,
17	30	1	30 1	37	60	NE	NE	Fair,	Fair,
18	30	1	30 1	41	62	NW	NW	Fair,	Fair,
19	30	0	29 9	51	66	N	N	Cloudy,	Fair,
20	30	0	30 0	44	54	NW	N	Fair,	Fair,
21	30	0	30 2	49	59	N	NW	Fair,	Fair,
22	29	6	29 5	51	65	NW	NW	Fair,	Fair,
23	29	8	29 8	47	60-	W	W	Fair,	Fair,
24	30	3	30 4	36	59	w	NW	Fair,	Fair,
25	30	4	30 3	46	71	S	S	Cloudy, Cloudy,	Do. h. w.
26	30	2	SO 2	60	72	Calm	SW		Cloudy,
27	30	3	30 3	44	44	NNE	NNE	Cloudy,	Cloudy,
28	30	2	30 1	34	37	N	N	Cloudy,	Cloudy,
29	29	85	29 85	28	44	NNW	NW	Fair,	Fair,
30	30	1	30 I	28	49	Calm	SW	Hazy,	Hazy,
31	30	15	30 2	42	45	Calm	NNE	Cloudy,	Rain.
 
124/          AN ACCOUNT OF THE
NOVEMBER, 1793.
	Barom.		Ther.		w	inds.	Weather.	
o5	£	£	£	£	£	£	£	£
at	<	£	<	&	<	&	<	£
	k	0*	t--	o*	k	0*	h-	Oi
1	30 1	30 1	40	41	NNE	NE	Rain,	Cloudy,
2	30 3	30 25	32	49	NNE	NE	Fair,	Fair,
3	30 1	30 0	43	56	Calm	SW	Cloudy,	Cloudy,
4	29 8	29 9	55	67	SW	SW	Cloudy,	Fair,
5	30 15	30 1	50	64	NE	NE	Rain,	Rain,
6	29 8	29 65	63	67	S	S	Cloudy,	Cloudv,
7	29 8	29 8	44	64	Calm	SW	Fair,	Fair, "
8	29 8	29 85	43	56	ssw	SW	Fair,	Fair,
9	29 9	29 95	42	64	SW	SWT	Fair,	Fair,
I 
BILIOUS YELLOW  FEVER OF 1793.
125
       OF THE METHOD OF CURE.

   IN the introduction to the history of the fever,  I men-
tioned the remedies which 1 used  with  success, in  several
cases which occurred  in the beginning of August. I had
seen, and recorded in my note book, the efficacy of gentle
purges in the yellow fever of 1762; but finding them un-
successful after the 20th of August, and observing  the dis-
ease to assume uncommon symptoms of great  prostration
of strength, I laid them aside, and had recourse to a gentle
vomit of ipecacuanha, on the first day  of the fever, and to
the usual remedies for exciting the action of the sanguife-
rous system. I gave bark in all its usual forms of infusion,
powder, and tincture.   I joined wine, brandy, and aroma-
tics with it. I applied blisters to the limbs, neck, and head.
Finding them all ineffectual,  I attempted to rouse the sys-
tem by wrapping the whole body, agreeably to Dr. Hume's
practice in blankets  dipped in warm  vinegar.  To these
remedies I added one more :  I rubbed  the  right side with
mercurial ointment,  with a view of exciting the action of
the vessels in the whole system through the medium of the
liver, which I then supposed to be  principally,  though
symptomatically, affected  by the  disease.   None of these
remedies appeared to be of any service  ; for although three
out of thirteen recovered,  of those to whom they were ap-
plied, yet I have reason to believe  that they would  have
recovered much sooner had the cure been trusted to nature.
Perplexed and distressed by  my want of success in the
treatment of this fever, I waited upon Dr. Stevens, an emi-
nent and worthy physician from St. Croix, who happened
then to be  in our city, and asked  for such  advice  and in-
formation upon the subject of the  disease,  as his extensive
practice in the West-Indies would naturally suggest.   He
politely informed me, that he had  long  ago laid aside eva-
cuations of all kinds in the yellow fever; that they had been
found to be hurtful, and that the disease yielded more  rea-
dily to bark, wine, and, above all, to the use of the  cold
bath.  He advised the bark to be  given in large quantities
by way of clyster, as well as in the usual way ;  and he in- 
126
AN ACCOUNT OF THE
formed me of the manner in which the cold bath should be
used, so as to derive the greatest benefit from it.  This mode
of treating the yellow fever, appeared to be reasonable. I had
used bark, in the manner he recommended it, in several cases
of sporadic yellow fever,  with success,  in former years. I
had, moreover,  the authority of several other physicians of
reputation in its favour.  Dr. Cleghorn  tells us, that " he
sometimes gave the bark when  the bowels were full of
vicious humours.  These humours (he  says) are produced
by the fault of  the circulation.  The bark, by bracing the
solids, enables them to throw off the excrementitious fluids,
by the proper emunctories."*
  I began the  use of each of Dr. Stevens's remedies the
next day after my interview with him, with great confidence
of their success.   I prescribed bark  in large  quantities:
in one case I ordered  it to be injected into the bowels every
four hour's.  I  directed  buckets  full of cold water to be
thrown frequently  upon my patients. The bark was  offen-
sive to the stomach, or rejected by it, in every case in which
I prescribed it.  The cold bath was  grateful, and produced
relief in several cases, by inducing a moisture on the skin.
For a while I had  hopes  of benefit to my patients from the
use of these remedies, but, in a few days, I was distressed
to find they were not  more effectual than those I had pre*
viously used.   Three out of four  of my patients died, to
whom the cold bath was administered,  in addition  to the
tonic remedies  before mentioned.
  Baffled  in every attempt to stop the ravages of this fever,
I anticipated all the numerous and complicated distresses
in our city, which  pestilential diseases have  so  often pro-
duced in other countries.  The fever had a  malignity and
an obstinacy which I had never  before observed in  any
disease, and it  spread with  a rapidity  and mortality far
beyond what it did in the year 1762.  Heaven alone bore
witness to the anguish of my soul in this awful  situation.
But I did  not abandon a hope that the disease might yet be
cured.  I had long believed that good was commensurate
with evil, and that there does not exist a disease for which
the goodness of Providence has not provided  a remedy.
Under the  impression of this belief I  applied myself with
fresh ardour to  the investigation of the  disease  before me.
I ransacked my library, and pored over every book  that
                       • Page 223. 
BILIOUS YELLOW FEVER  OF 1793.
127
treated of the yellow fever.   The result of my researches
for a while was fruitless.   The accounts of the symptoms
and cure  of the disease  by the authors  I consulted were*
contradictory, and none of them appeared  altogether appli-
cable to the prevailing epidemic.  Before  I desisted from
the inquiry to which I had devoted myself,  I recollected
that I had, among some old papers, a manuscript account
of the yellow fever as it  prevailed in Virginia in the year
1741, which had been put into my hands by Dr. Franklin,
a short time before his death.   I had read  it formerly, and
made extracts from it into my lectures upon  that disease.
I now read it  a second time. I paused upon every sentence:
even words in some places arrested and fixed my attention.
In reading the history of the method of cure I was much
struck with the following passages.
   " It must be  remarked, that this evacuation (meaning
by purges) is more necessary  in this than in most other
fevers.   The abdominal viscera are the  parts principally
affected in this disease, but by this  timely evacuation their
feculent corruptible contents  are discharged, before they
corrupt and produce any ill effects, and their various emunc-
tories  and secerning vessels  are  set open, so as to allow
a free discharge of their contents, and consequently a secu-
rity to the parts themselves, during the course  of the dis-
ease.   By this  evacuation the very minera of the disease,
proceeding from the putrid miasmata fermenting with the
salivary, bilious, and other inquiline humours of the body,
is sometimes eradicated by timely emptying the abdominal
viscera, on which it first fixes, after which a  gentle sweat
does as it were nip it  in  its  bud.   Where the primae viae,
but especially the stomach,  is  loaded  with an  offensive
matter, or contracted and convulsed with the irritation of
its stimulus, there is no procuring a laudable  sweat till that
is  removed;  after which a  necessary  quantity  of sweat
breaks out of its own  accord, these parts promoting it when
by an absterging medicine they are eased  of the burden or
stimulus  which oppresses them."
   " All these acute  putrid fevers ever require some eva-
cuation to bring them to a perfect crisis and  solution, and
that even by stools, which must be promoted by art, where
nature does not do the business herself.  On  this account
an ill-timed scrupulousness about the weakness of the body 
128
AN ACCOUNT OF THE
is of bad consequence in these  urging circumstances;  for
it is that which seems chiefly to make evacuations  neces-
sary, which nature ever attempts, after the humours are fit
to be expelled, but is  not able to accomplish  for the most
part in this disease; and  I can affirm that  I have given a
purge in this case, when the pulse has been so low,  that it
could hardly be felt, and the debility extreme, yet both one
and the other have been restored by it."
  " This evacuation must be procured by lenitive chologo-
que purges."
  Here I paused.  A new train of ideas suddenly  broke
in upon my  mind.  I believed the weak  and low pulse
which  I had observed in  this fever, to be the effect of de-
bility from a depressed state of the system.,  but  the unsuc-
cessful issue of purging,  and even of a spontaneous diarr-
hoea, in a patient of Dr. Hutchinson, had led me not only
to doubt of, but to dread its effects.   My fears from this
evacuation were confirmed, by  the  communication  I had
received from Dr. Stevens.  I had  been  accustomed to
raising a weak and low pulse in pneumony  and apoplexy,
by means of blood-letting, but I had attended less to the
effects of purging in producing this change in the pulse.
Dr.  Mitchell  in  a moment  dissipated my ignorance and
fears upon this subject.  I adopted his theory and practice,
and resolved to follow them.   It remained  now only to fix
upon a suitable purge to answer the  purpose of dischar-
ging the contents  of the bowels.  I have before described
the state of the bile in the gall-bladder and duodenum, in
an extract from the history of a dissection  made by Dr.
Mitchell.   I suspected that my want  of success  in dis-
charging this bile, in  several of the cases  in which I at-
tempted the cure by purging, was owing to the feebleness
of my  purges.  I  had been  in the habit  of occasionally
purging with calomel  in bilious and  inflammatory  fevers,
and had recommended the practice the year before  in  my
lectures, not only from my own experience, but upon  the
authority  of Dr.  Clark.   I had,  moreover,  other  prece-
dents for its use in the practice of Sir John Pringle, Dr.
Cleghorn, and Dr. Balfour, in diseases of  the same class
with the yellow fever.  But these were not all my vouchers
for the safety and efficacy of calomel.  In my attendance
upon the military hospitals during the late war,  I had seen 
BILIOUS YELLOW FEVER OF 1793.       129
it given combined with  jalap in the bilious fever by Dr.
Thomas Young, a senior surgeon in the hospitals.  His
usual dose was  ten  grains of  each of them.   This  was
given once or twice  a day  until it procured large evacua-
tions from the bowels.   For a while  I remonstrated with
the doctor against this purge, as being disproportioned  to
the  violence  and danger of the fever; but I was soon sa-
tisfied that it was as safe as cremor tartar or Glauber's salts.
It was adopted by several of the surgeons of the hospital,
and was universally known, and sometimes prescribed, by
the simple name of ten and ten.   This mode of giving ca-
lomel occurred to me in  preference to any other.  The ja-
lap  appeared to be a necessary addition to it,  in order to
quicken its  passage  through the bowels; for calomel is
slow in its operation, more especially when it is given  in
large doses.   I resolved, after mature deliberation, to pre-
scribe this purge.  Finding ten grains of  jalap  insufficient
to carry the calomel through the bowels  in the rapid man-
ner I wished, I added fifteen grains-of the former to ten of
the latter ; but even  this  dose was slow and uncertain in  its
operation.  I then issued three doses, each consisting  of
fifteen grains of jalap and ten of calomel;  one to be given
every six  hours  until they procured four or five large eva-
cuations.  The  effects of this powder not only answered,
but far exceeded my expectations.  It perfectly cured four
out of the first five patients to  whom I gave it,  notwith-
standing some of them were  advanced several days in the
disease.    Mr. Richard Spain,  a block-maker,  in  Third
street, took eighty grains of calomel, and rather more  of
rheubarb  and jalap mixed with it, on the  two last days of
August,  and on  the first day of  September.  He had
passed twelve hours,  before I began to give him this medi-
cine,  without a pulse, and with a  cold sweat on  all his
limbs.   His relations had given him over, and  one of his
neighbours complained to me  of my neglecting to advise
them to make immediate preparations for his .funeral.  But
in this situation I did not despair  of his recovery.  Dr.
Mitchell's account of the effects of purging in  raising the
pulse, excited a hope that he might be saved, provided his
bowels could be opened.   I now committed the exhibition
of the purging medicine  to Mr. Stall, one .of my pupils,
who mixed it, and  gave it with his  own hand,  three  or
   VOL. III.               R 
130
AN  ACCOUNT OF THE
four times a day.  At length it operated, and produced two
copious, foetid stools.  His pulse rose immediately  after-
wards, and an universal moisture on his skin succeeded the
cold sweat on his limbs.  In a few days he was out of dan-
ger, and soon afterwards appeared in the  streets in good
health, as the first fruits of the efficacy of mercurial purges
in the yellow fever.
   After such a pledge of the safety and success of my new
medicine, I gave it with  confidence.   I communicated the
prescription to  such of the practitioners as I met in the
streets.   Some of them I found had been*in the use of ca-
lomel for  several days,  but as they had given it in  small
and single  doses only, and had followed it by large doses
of bark, wine,  and laudanum, they had done little or no
good with  it.  I imparted the prescription to the college of
physicians, on the third of September, and endeavoured to
remove the fears of my  fellow-citizeits, by assuring them
that the disease was no longer incurable.  Mr. Lewis, the
lawyer,  Dr. M'llvaine, Mrs. Bethel,  her two sons, and a
servant maid, and Mr. Peter Baynton's whole family  (nine
in number,)  were some of the first trophies of this new re-
medy.  The credit it acquired, brought me an immense
accession of business.  It still continued to be almost uni-
formly effectual in all those which I was able to attend,
either in person, or by my pupils.  Dr. Griffitts, Dr. Say,
Dr. Pennington, and my former pupils who had settled in
the city, viz. Dr. Leib, Dr. Porter, Dr. Annan, Dr. Wood-
house, and Dr. Mease, were among the first physicians who
adopted  it.  I can  never forget the  transport with which
Dr. Pennington ran across Third street to inform me, a few
days after he began to give strong purges, that the disease
yielded  to them in every case.  But I did not rely upon
purging alone to cure the disease.  The theory of it which
I had adopted led me to use other remedies to abstract ex-
cess of stimulus from the  system.  These were blood-letting,
cool air, cold drinks, low diet, and applications of cold water
to the bod\-.  I had  bled Mrs. Bradford, Mrs. Learning,
and one of Mrs. Palmer's sons without success, early  in the
month of August.   But  I had witnessed the bad effects of
bleeding in the first week in September, in two of my pa-
tients who  had bled without my knowledge, and who ap-
peared to have died in consequence of it.  I had,  mow- 
          BILIOUS YELLOW FEVER OF 1793.        131

over, heard of a man who had been bled on the first day of
the disease, who had  died in twelve hours afterwards.
These cases produced caution, but they did not deter me
from bleeding as soon as I  found the disease to change its
type, and instead of tending to a crisis on the third, to pro-
tract itself  to a later day.   I  began by drawing a small
quantity at  a time.  The appearance of the blood, and its
effects upon the system, satisfied me of its safety and  effi-
cacy.   Never before did I experience such sublime joy as
I now felt  in contemplating the  success of my remedies.
It repaid me for all the toils and studies of my life.  The
conquest of this formidable  disease was not  the effect of
accident, nor of the application of a single remedy ; but it
was the triumph of a principle in medicine.  The reader
will not wonder at this joyful state of my mind when I add
a short extract from my note book,  dated the 10th of Sep-
tember.  " Thank God!  out of one hundred patients,
whom I have visited or prescribed for this day, I have lost
none."
  Being unable to comply with the numerous demands
which were made upon me for the purging powders,  not-
withstanding I  had requested my sister, and two other per-
sons to assist my pupils in putting them up ; and, finding
myself unable to attend all the persons who sent for me,  I
furnished the apothecaries with the recipe for  the mercurial
purges, together with  printed directions  for  giving them,
and for the treatment of the disease.
  Hitherto there had been  great harmony  among the phy-
sicians of the city, although there was  a diversity of senti-
ment as to  the nature and cure of the prevailing fever.  But
this diversity of sentiment and practice was daily lessening,
and would  probably have ceased altogether in a few days,
had it not been prevented by two publications, the one by
Dr. Kuhn,  and the other by Dr. Stevens, in which they re-
commended bark, wine, and other cordials, and the  cold
bath, as  the proper remedies for the disease.  The latter
dissuaded from the use of evacuations of all kinds.   This
method of cure was supported by a letter from Alexander
Hamilton. Esq. then secretary of the treasury of the United
States, to the college of physicians, in which he ascribed
his recovery from the fever to the use  of  those remedies,
administered by the hand of Dr. Stevens.   The respectable 
132            AN ACCOUNT  OF THE

characters of those two physicians procured an immediate
adoption of the mode of practice recommended  by them,
by most of the physicians of the  city,  and a general confi-
dence in it by all classes of citizens.  Had I consulted my
interest, or regarded the certain consequences of opposing
the  use of remedies  rendered  suddenly popular  by the
names that were connected  with them, I should  silently
have pursued my own plans  of cure,  with my old patients
who still confided in them ; but I felt, at this season of uni-
versal distress, my professional obligations to all the citizens
of Philadelphia to be  superior to private and personal consi-
derations, and therefore determined at every hazard to do
every thing in my power to save their lives. Under the in-
fluence of this disposition, I addressed a letterto the college
of physicians, in which I stated my objections to Dr. Kuhn
and Dr.  Stevens's remedies,  and defended those I had re-
commended. I likewise defended them in the public papers
against  the attacks that  were made upon them by several
of the physicians of the city, and occasionally addressed such
advice to the citizens as experience had  suggested to  be
useful to prevent the disease, particularly low diet,  gentle
doses of laxative physic, avoiding its exciting causes, and
prompt applications for  medical aid.  In none of the re-
commendations of my remedies  did I claim the credit of
their discovery.  On the contrary, I constantly endeavoured
to enforce their adoption by mentioning precedents in favour
of their efficacy, from the highest authorities in medicine.
This controversy with my brethren, with whom I had long
lived in  friendly intercourse, carried  on amidst the most
distressing labours, was extremely  painful to me, and w7as
submitted to only to prevent the greater evil of the depopu-
lation of our city by the use of remedies which  had been
prescribed by myself, as well as others, not only without
effect,  but with evident injury to the sick.  The repeated
and numerous instances of their inefficacy, in some of the
most opulent families in the city, and the almost uniform
success of the depleting remedies, happily restored the pub-
lic mind,  after a while, from its distracted state, and pro-
cured submission to the latter, from nearly all the persons
who were affected by the fever.
  Besides the two modes of  practice which have been de-
scribed, there were two others: the one consisted of mode- 
          BILIOUS YELLOW FEVER OF 1793.        133

rate purging with calomel only, and moderate bleeding, on
the first or second day of the fever, and afterwards by the
copious use of bark, wine, laudanum, and aromatic tonics.
This practice was supported by an opinion,  that the fever
was inflammatory  in its first, and putrid in its second stage.
The other mode referred to was peculiar to the French
physicians, several of whom had  arrived in  the city from
the West-Indies,  just before the disease made its appear-
ance.   Their remedies were various.   Some of them  pre-
scribed nitre, cremor tartar,  camphor, centaury  tea,  the
warm bath, clysters, and moderate bleeding, while a few
used lenient purges, and large quantities of tamarind water,
and other diluted drinks.  The dissensions of the American
physicians threw a great number of patients into the hands
of these French physicians. They were moreover supposed
to be better acquainted with the disease than the physicians
of the city, most  of whom, it was well known, had never
seen it before.
   I shall hereafter inquire into the relative success of each
of the four modes of practice which have been mentioned.
   Having delivered a general account of the remedies which
I used  in this disease, I shall now proceed to make a few
remarks upon each of them.  I shall afterwards mention the
effects of the remedies used by other physicians.
OF  PURGING.
  I HAVE  already mentioned my reasons  for  promot-
ing this evacuation,  and the medicine  I preferred for that
purpose.   It had  many advantages  over any  other purge.
It was detergent  to  the bile  and mucus which lined the
bowels.  It probably acted in a peculiar manner upon the
biliary ducts, and it was rapid in its operation.  One dose
was sometimes sufficient to open the bowels; but from two
to six doses wrere often necessary for that purpose; more
especially as part  of them was frequently rejected by  the
stomach.   I did not observe any inconvenience from the
vomiting which was  excited  by the jalap.  It was always 
134              AN ACCOUNT OF THE

without that straining which was produced by emetics; and
it  served to discharge bile  when it was lodged in the sto-
mach.  Nor did I rest the discharge of the contents of the
bowels on  the issue of one  cleansing on  the first day.
There is, in all bilious fevers,  a reproduction of morbid
bile as fast as it is discharged. I therefore gave a purge every
day while the fever continued.   I  used  castor oil, salts,
cremor tartar, and rheubarb  (after the mercurial purges had
performed their office,) according to the inclinations of my
patients, in all those cases  where the bowels were easily
moved;  but where this was not the case,  I gave a  single
dose of calomel and jalap every day.  Strong as this purge
may be  supposed to be, it was often ineffectual;  more es-
pecially after the 20th of September, when the bowels be-
came  more  obstinately constipated.   To supply the place
of the jalap,  I  now added gamboge  to the calomel.  Two
grains and a  half of each, made into a pill, were given to an
adult  every  six  hours, until they procured four or five
stools.   I had  other  designs in giving a purge every day,
besides discharging  the re-accumulated bile.  I had ob-
served the fever to fall with its principal force upon such
parts of the body as had been previously weakened by any
former disease.  By creating  an artificial weak part in the
bowels, I diverted the force of the fever to them, and there-
by saved the liver and brain from fatal or dangerous con-
gestions.  The practice was further justified by the bene-
ficial effects of a plentiful and spontaneous diarrhoea, in the
beginning of the disease ;* by haemorrhages from the bow-
els, when they occurred from no other parts of  the body,
and by the  difficulty or impracticability  of reducing the
system by means of plentiful  sweats.   The purges seldom
answered the intentions for which they were given,  unless
they  produced four or five stools a day.   As  the fever
showed no regard to day or night in the hours of its exa-
cerbations, it became necessary to observe the same disre-
gard  to time in the exhibition of purges : I therefore pre-

  *  In some short manuscript notes upon Dr. Mitchell's account of the yellow
fever in Virginia, in the year 1741, made by the late Ur. Kearsley, sen. of this
city, he remarks, that in the yellow fever which prevailed in the same year in
Philadelphia, "some recovered by an early discharge of black matter by stool."
This gentleman,  Dr. Redman informed me, introduced purging with Glauber's
salts in the yellow fever in our city.   He was preceptor to Dr. Redman in me
dicine.                           , 
BILIOUS YELLOW FEVER OF 1793.
135
scribed them in the evening, at all times when the patient
had passed  a day without  two or three plentiful  stools.
When purges were rejected, or slow  in their operation, I
always directed opening clysters to be  given every two
hours.  The effects of purging were as follow:
   1.  It raised the pulse when low, and reduced it when it
was preternaturally tense or full.
   2.  It  revived  and strengthened the patient.  This was
evident in many cases, in  the facility  with which patients
who had staggered to a close-stool, walked back again  to
their beds after a  copious evacuation.  Dr. Sydenham takes
notice of a similar increase  of strength after a plentiful sweat
in the plague.  They both acted by abstracting excess  of
stimulus, and thereby removing the  depression  of the
system.
   3.  It abated the paroxysm of the fever.  Hence arose the
advantage of giving a purge in some cases in the evening,
when an attack of the fever  was expected in the course  of
the night.
   4.  It frequently produced sweats when given on the first
or second day of the fever, after the most  powerful sudori-
fics had  been taken to no  purpose.
   5.  It sometimes checked that vomiting which occurs in
the beginning of the disease, and it always assisted in pre-
venting  the  more alarming occurrence  of that symptom
about the 4th or  5th day.
   6.  It removed obstructions  in the lymphatic system.   I
ascribe  it wholly to  the action of mercury, that in  no in-
stance did any of the glandular swelling,  which I formerly
mentioned, terminate in a suppuration.
   7.  By discharging the  bile through the bowels as soon
and as fast as it was secreted, it prevented, in  most cases, a
yellowness of the skin.
   However  salutary  the  mercurial purge was,  objections
were  made to it by many of our physicians; and prejudices,
equally  weak and ill-founded,  were  excited against  it.   I
shall enumerate, and  answer those objections.
   1.  It was said  to be of too drastic a nature.  It was com-
pared to arsenic; and  it was  called a dose  for a  horse.
This  objection was  without foundation.   Hundreds who
took it declared they had  never taken so mild a purge.   I 
136
AN ACCOUNT  OF  THE
met with but one case in which it produced bloody stools;
but I saw the same effects from  a dose of salts.   It some-
times, it is  true, operated from  twenty to thirty  times in
the  course of twenty-four hours; but  I heard of  an equal
number of stools in two cases from salts and cremor tartar.
It is not an easy thing to affect life,  or even subsequent
health, by  copious or  frequent  purging.   Dr.  Kirkland
mentions a remarkable case of a gentleman who was cured
of rheumatism, by a purge, which gave him between  40
and 50  stools.   This patient had been previously affected
by his disease  16  or  18 weeks.*  Dr. Moseley not only
proves the safety, but establishes the efficacy of numerous
and copious stools in the yellow  fever.  Dr. Say  probably
owes nis life to three and twenty  stools procured by a dose
of calomel and gamboge, taken by my advice.   Dr. Red-
man was purged until he fainted by a dose of the same
medicine.   This venerable gentleman,  in whom  70 years
had not abated the ardour of humanity,  nor produced obsti-
nacy of  opinion,  came  forward  from  his retirement,  and
boldly adopted the remedies of purging and  bleeding, with
success in several families, before he was attacked  by the
disease.  His recovery was as rapid, as the medicine he had
used was active in its  operation.   Besides taking the above
purge, he lost twenty ounces of blood by two bleedings.f
   But who  can suppose that a dozen or twenty stools in a
day could endanger life, that has seen  a diarrhoea continue
for  several months, attended with fifteen or twenty stools
every day,  without making even a material  breach in the
constitution ?  Hence  Dr. Hillary has justly remarked, that

  * Treatise on the Inflammatory Rheumatism, vol. i. p. 407.
  f Dr. Redman was not the only instance furnished by the disease,  in which
reason got the better of the habits of old age, and of the formalities of medi-
cine.  About the time the fever declined, I received a letter from Dr. Shippen,
sen (then above 82 years of age,) dated Oxford Furnace, New -Jersey, October
loth, 1793, in'which, after approving in polite terms of my mode of practice,
he adds, " Desperate diseases require desperate remedies.  I would only pro-
pose some small addition to your present method.  Suppose }Ou  should sub-
stitute, in the room of the jalap, six grains of gamboge, to be mixed with ten
or fifteen grains of calomel; and after a dose or two, as occasion may  require,
you should bleed your patients almost to death, at least to fainting ,• and then
direct a plentiful supply of mallows tea, with fresh lemon juice, and sugar and
barley water, together with the most simple, mild and nutritious food."  The
doctor concludes his letter by recommending to my perusal Dr. Lover's account
of nearly a whole ship's crew having been cured of a yellow fiver,  on the coast
of South America, by being bled until they fainted. 
        THE BILIOUS YELLOW FEVER OF 1793.     137

lt it rarely or never happens that the purging in this disease,
though violent, takes the patient off,  but the fever and in-
flammation of the bowels."*  Dr. Clark in like manner re-
marks, that evacuations do not destroy life in the dysentery,
but the fever, with the emaciation and mortification which
attend and follow the disease.f
  2. A second objection to this mercurial purge was, that
it excited a salivation, and sometimes loosened the teeth.  I
met with but two cases in which there was a loss of teeth
from the use of this medicine,  and in both the teeth were
previously loose or decayed.   The salivation  was a trifling
evil, compared with the benefit  which  was derived from it.
I lost only one patient in whom  it occurred.   I was taught,
by this  accidental effect of mercury,  to administer it with
other views than merely to cleanse the bowels,  and with a
success which  added much to my confidence in the power
of medicine over the  disease.   I shall  mention those views
under another head.
  3. It was said that the mercurial purge excoriated  the
rectum, and produced the symptoms of pain and inflam-
mation in that part, which were formerly mentioned.
   To refute this charge, it will be sufficient to remark,  that
the bile produces the same excoriation and pain in the  rec-
tum in the bilious and yellow fever, where no mercury has
been given  to discharge it.   In the bilious remitting fever
which prevailed  in Philadelphia, in 1780,  we find the bile
which was discharged by " gentle doses of salts, and cremor
tartar, or the butternut pill, was so acrid as to excoriate the
rectum, and so offensive as to occasion, in some cases, sick-
ness and faintness both in the patients and in their atten-
dants.":!:
  Dr.  Hume says further upon this subject, that  the  rec-
tum was so much excoriated by the natural discharge of
bile in the yellow fever, as to render it  impossible to intro-
duce a clyster pipe into it.
  4.   It was objected to this  purge, that it inflamed  and
lacerated  the  stomach and  bowels.    In- support of  this
calumny,  the  inflamed and mortified appearances,  which
those viscera  exhibited  upon  dissection in  a patient  who

 • Diseases of Tlarbadoes, p. 212.
 f  Diseases in Voyages to Hot Climates, vol. ij. p.  32?.
  t  Vol  i.
VOL.  III.
s 
138
AN ACCOUNT OF THE
died at the hospital at Bush-hill, were spoken of with hor-
ror in some parts of the, city.  To refute this objection, it
will only be necessary to review the account formerly given
of the state of the stomach and bowels after death from  the
yellow fever, in cases in which no  mercury had been given.
I have before  taken notice that sir John Pringle and Dr.
Cleghorn had prescribed mercurial purges with success in
the dysentery,  a disease in which the bowels are affected
with more irritation and inflammation than in the yellow fe-
ver. Dr. Clark informs us that he had adopted this practice.
I shall insert the eulogium of this  excellent physician  upon
the use of mercury in  the  dysentery, in his own words.
" For several  years past, when the dysentery has resisted
the common mode of practice, I have administered mercu-
ry with the greatest success ; and am thoroughly persuaded
that it is possessed of  powers to remove inflammation and
ulceration of the intestines, which are the chief causes of
death  in this distemper."*
   5. It was urged against this powerful and efficacious me-
dicine, that it was prescribed indiscriminately in all cases,
and that it did harm in all weak habits.  To this I answer,
that there was no person so weak in constitution  or a previ-
ous disease, as to be injured by a  single dose of this medi-
cine.  Mrs. Meredith, the wife of the treasurer of the United
States, a lady of uncommon delicacy of constitution,  took
two doses of the powder in the course of twelve hours, not
only without any inconvenience, but with an evident  in-
crease of strength soon afterwards.   Many similar  cases
might be mentioned.   Even  children took two or  three
large doses of it with perfect safety. This will not surprise
those  physicians who have been in the practice of giving
from ten to twenty grains of mercury, with an equal quan-
tity of jalap  as a worm purge,  and from  fifty to a hundred
grains of calomel, in the course of four or five days, in the
internal dropsy of the brain.  But I am happy in being able
to add further, that many women  took it  in every stage of
pregnancy without suffering the least inconvenience from it.
Out of a great number of pregnant women whom I attend-
ed in thrs  fever I did not lose one to whom I gave this me-
dicine, nor did any of them suffer an abortion. One of  them
had twice miscan-ied in the course of the two or three last
* Vol. ii. p. 342. 
BILIOUS YELLOW FEVER  OF 1793.       139
 years of her life.   She bore a healthy child three months
 after her recovery from the yellow fever.
   No one has ever objected to the indiscriminate mode of
 preparing the body for the small-pox by purging medi-
 cines.   The uniform inflammatory diathesis of that disease
justifies the practice, in a certain degree, in all habits.  The
 yellow fever admits of a sameness of cure much more than
 the small-pox, for it is more uniformly and more highly in-
 flammatory.  An observation of Dr. Sydenham upon  epi-
 demics,  applies, in its utmost  extent, to our  late  fever.
 " Now it must be observed (says this most acute physician)
 that some epidemic diseases, in some years, are uniformly
 and constantly the same."*  However diversified our fever
 was in some of its  symptoms, it was in all cases accompa-
 nied by more or less inflammatory diathesis, and by a mor-
 bid state of the alimentary canal.
   Much has been said of the bad effects of this purge from
 its having been put  up carelessly by the apothecaries, or from
 its having been taken  contrary to the printed directions by
 many people.  If it did harm in any one case (which I do
 not believe) from the former of the above causes the fault is
 not mine.  Twenty men employed constantly in putting up
 this medicine would not have been sufficient to have com-
 plied with all the demands  which were made of me for it.
 Hundreds who were in health called or sent for it as well as
 the sick, in order to have it in readiness, in case they should
 be surprised by the disease in the night, or at a distance in
 the night, or at a distance from a physician.
   In all the cases in which this  purge  was supposed to
 have  been hurtful, when given on the first or second  day
 of the disease, I believe it was because it was not followed
 by repeated doses of the same, or of some other purge, or
 because  it was  not aided by  blood-letting.  I am led to
 make this  assertion,  not only from the authority of  Dr,
 Sydenham,  who often mentions the good effects of bleed-
 ing in moderating  or checking a diarrhoea, but by having
 heard no complaints of patients being purged  to death by
 this medicine, after blood-letting was universally adopted
 by all the physicians in the city.
   It was remarked, that the demand for this purging pow-
 der continued to increase under all opposition, and that  the
                       • Vol. i. p. 9. 
140
AN ACCOUNT  OF THE
sale of it by the apothecaries was greatest towards the close
of the disease.   I shall hereafter say  that this was not the
case with the West-India remedies.
   It is possible  that this purge sometimes proved  hurtful
when it was given  on the fifth day of the disease,  but it
was seldom given for the flrst time after the third day, and
when it was,  the patient was generally in such a situation
that nothing did him either good or harm.
   ■I derived great pleasure from hearing, after the fever had
left the city, that calomel had been given with success as a
purge in bilious fevers in other parts  of the Union besides
Philadelphia. Dr. Lawrence informed me that he had cured
many patients by it of the yellow  fever which prevailed in
New-York, in the year  1791, and the New-York papers
have told us that several practitioners had been in the habit
of giving it in the autumnal fevers, with  great success, in
the western parts of that state.  They had probably learned
the use of  it from Dr.  Young,  who  formerly practised in
that part of the United States, and who lost no opportunity
of making  its praise public wherever he went.
   I have only to add to my account of that purging medi-
cine, that, under an expectation that the yellow fever would
mingle some of its bilious symptoms  with the common in-
flammatory fevers of the winter  and first spring months, I
gave that purge  in the form of pills, in every case of inflam-
matory fever to which  I was called.   The fatal issue of se-
veral fevers in the city, during the  winter, in which this pre-
caution had been neglected, convinced me that my practice
was proper and  useful.
   It is to be lamented that all new remedies are forced to
pass through a fiery ordeal.   Opium  and bark were long
the objects of terror and invective in the schools of medi-
cine.  They were administered only by physicians for ma-
ny years, and that too w ith all the solemnity  of a religious
ceremony.  This error, with respect to those medicines, has
at last passed away. It w ill, I hope, soon be succeeded by a
time when  the prejudices against ten and ten or ten and fif-
teen,  will sleep  with the vulgar fears  which were formerly
entertained of the bark producing diseases and death, years
after it had been taken, by '«lying in  the bones." 
BILIOUS YELLOW FEVER OF 1793.
141
             OF  BLOOD-LETTING.


  THE  theory of this fever which led me to administer
purges, determined me to use blood-letting, as soon as it
should be indicated.   I am disposed to believe that I was
tardy in the use of this remedy, and I shall long regret the
loss of three patients, who might probably have been saved
by it.  I cannot blame myself for not having used it ear-
lier,  for the immense number of patients which poured in
upon me, in the  first week of September, prevented my
attending  so  much to each of them as was necessary to
determine upon the propriety of this evacuation.  I was in
the situation of a surgeon  in a battle, who runs to every call,
and  only  stays  long enough with each soldier to stop die
bleeding of his wound, while the increase of the wounded,
and  the unexpected  length of the battle,  leave his original
patients to suffer  from the want of more suitable dressings.
The reasons which determined me to bleed were,
   1. The state of the pulse, which became more tense, in
proportion as the  weather became cool.
  2. The appearance of  a moist and white tongue, on the
first  day of the disease,  a certain sign of an inflammatory
fever.
  3. The frequency of haemorrhages from every  part of
the  body, and  the perfect relief given in some cases  by
them.
  4. The  symptoms of congestion  in the brain,  resem-
bling those which occur in the first stage of hydrocephalus
internus, a disease in which I had lately used bleeding with
success.
  5. The character of the diseases which had preceded the
yellow fever.   They were all  more or less inflammatory.
Even the  scarlatina anginosa had partaken so much of that
diathesis, as to require bleeding to subdue it.
  6.  The warm and dry weather which had likewise pre-
ceded the fever.  Dr. Sydenham attributes a highly inflam-
matory state of the small-pox to a previously hot and dry
-ummcr; and I have since observed, that Dr. Hillary takes 
142
AN ACCOUNT OF THE
 notice of inflammatory fevers having frequently succeeded
 hot and dry weather in Barbadoes.*  He informs us fur-
 ther, that the yellow fever is always most acute and inflam-
 matory after a very hot season, f
   7. The authority of Dr. Mosely  had great weight with
 me in  advising the loss of blood, more  especially as his
 ideas of the highly inflammatory nature of the fever accord-
 ed so perfectly with my own.
   8. I was induced to prescribe blood-letting by recollect-
 ing its good effects in Mrs. Palmer's son, whom I bled on
 the 20th of August,  and who appeared to have been reco-
 vered by it.
   Having begun to bleed, I was encouraged to continue it
 by the appearance of the blood, and by the  obvious  and
 very great relief my patients derived from it.
   The following is a short account of the appearances of
 the blood drawn from a vein in this disease.
   1.  It was, in the greatest number of cases, without  any
 separation into crassamentum and serum,  and of a scarlet
 colour.
   2.  There was in many cases a separation of the blood
 into crassamentum and yellow serum.
   3.  There were a few cases in which this separation took
 place and the serum was of a natural colour.
   4.  There were many cases  in which the blood  was as
 sizy as in pneumony and rheumatism.
   5.  The blood was in some instances covered above with
 blue pellicle of sizy lymph, while the part which lay in the
 bottom of the bowl was dissolved.  The lymph was in two
 cases mixed with green streaks.
   6.  It was in a few instances of a dark colour, and as fluid
 as molasses.  I saw this kind of blood in a man who walk-
 ed  about  his house during the whole of his sickness, and
who finally recovered.   Both this, and the fifth  kind of
blood which has been mentioned, occur chiefly where bleed-
ing had been omitted altogether, or used  too sparingly in
the beginning of the disease.
   7. In some patients the blood, in the course of the dis*
ease,  exhibited nearly all the appearances which have been
mentioned.  They were varied  by the time in which the

  * Diseases of Barbadoes, p. 16, 43, 46, 48, 52, 122.        f Page 174. 
BILIOUS YELLOW  FEVER OF 1793.       143
tyood was drawn, and by the nature and force of the reme-
dies which have been used in the disease.
  The  effects  of blood-letting upon the  system were  as
follow:
  1. It raised the pulse when depressed, and quickened it,
when it was preternaturally slow, or subject to intermis-
sions.
  2. It reduced its force and frequency.
  3. It checked in many cases the vomiting  which occur-
red in the beginning of the disease, and thereby enabled the
stomach to retain the purging medicine. It likewise assist-
ed the purge in preventing the dangerous or fatal vomiting
which came on about the fifth day.
  4. It lessened the difficulty of opening the bowels.  Up-
on this account, in one of my addresses to the citizens of
Philadelphia, I advised bleeding to be used before, as well
as after  taking the mercurial purge.  Dr.  Woodhouse in-
formed  me that he had several times seen patients call for
the close-stool while the blood was flowing from the vein.
  5.  It removed delirium,  coma, and obstinate wakeful-
ness.   It also prevented or checked haemorrhages ; hence
perhaps another reason why not a single instance  of  abor-
tion occurred in such of my female patients as were  preg-
nant.
  6. It disposed, in some cases, to a gentle perspiration.
  7. It lessened the muscular debility of the system ; hence
patients frequently rose from their beds, and walked across
their rooms,  in a few hours after the operation had been
performed.
  8.  The  redness of the eyes frequently disappeared in a
few hours  after bleeding.   Mr. Coxe  observed a dilated
pupil to contract to its natural size within a  few  minutes
after he had bound up the arm of his patient.  I remarked,
in the former part of this work, that blindness in many in-
stances attended or followed this fever.  But two such cases
occurred among my patients.  In  one  of them it was  of
short continuance,  and in the other it was probably occa-
sioned by the want of sufficient bleeding.   In every  case
of blindness that came to my knowledge bleeding had been
omitted, or used only in a very moderate degree.
  9.  It eased pain.  Thousands can testify this effect  of
blood-letting.   Many of my patients whom  I  bled with 
144
AX  ACCOUNT OF THE
my own hand acknowledged to  me, while the blood was
flowing, that they were better; and some of them declared,
that  all their pains had left them before I had  completely
bound up their arms.
   10.  But blood-letting had, in many cases, an effect the
opposite of easing pain.  It frequently increased it in every
part of the body, more especially in the head.   It appeared
to be the effect of the  system rising suddenly from a state
of great depression, and of an increased action of the blood-
vessels which took place in consequence of it.   I had fre-
quently seen complaints of the breast,  and of the  head,
made worse by a single bleeding, and from the same cause.
It v-  m some cases an unfortunate event in the yellow fe-
ver,  for it prevented the blood-letting being repeated, by
exciting or strengthening the  prejudices of patients  and
physicians, against it.  In some instances the patients grew
worse  after a second,  and,  in one, after a third bleeding.
This was the  case in Miss Redman.   Her pains increased
after three bleedings, but yielded to the fourth.  Her father,
Dr. Redman,  concurred in this seemingly absurd practice.
It was at this time my old preceptor in medicine reminded
me of Dr.  Sydenham's remark, that moderate bleeding did
harm in the plague v/here copious bleeding wras indicated,
and that in the cure of that disease, we should leave nature
wholly to  herself, or take the  cure altogether out of her
hands.  The truth of  this remark was very obvious.  By
taking away as much blood as restored the blood-vessels
to a  morbid degree of action, without reducing this  action
afterwards, pain,  congestion, and inflammation were  fre-
quently increased, all  of which  were prevented, or occur-
red in a less degree, when the system rose gradually from
the state of depression which had been induced by the great
force of the disease.  Under the influence of the facts  and
reasonings which have been mentioned I bore the same
testimony in acute cases, against what was called moderate
bleeding that I did against bark, wine, and  laudanum in
this fever.
   11.  Blood-letting, when used early on the first day, fre-
quently strangled the disease in its birth, and generally ren-
dered  it more  light, and the convalescence more speedy
and perfect.  I am not sure that it ever shortened the du-
ration  of the fever  where it wras not used within  a  few 
         BILIOUS  YELLOW FEVER OF 1793.        145

hours of the time of its attack.   Under  every mode  of
treatment it seemed disposed, after it was completely form-
ed, to run its course.   I was so satisfied of this  peculiarity
in the fever, that I ventured in some cases to  predict the
day on which it would terminate,  notwithstanding  I took
the cure entirely out of the hands of nature.   I  did  not
lose a patient on the third, whom  I bled on tfae first or se-
cond day of the disease.
   12. In those cases which ended fatally, blood-letting re-
stored, or preserved the use of reason, rendered  death easy,
and retarded the putrefaction of the body after death.
   I shall now mention some of  the  circumstances which
directed and regulated the use of this remedy.
   1. Where bleeding had been omitted for  three  days, in
acute cases, it was  seldom  useful.  Where  purging had
been used, it was sometimes successful.  I recovered two
patients who had taken the mercurial purges, whom I bled
for the first time on the seventh  day.  One  of them was
the daughter of Mr. James Cresson,  the other was a jour-
neyman  ship-carpenter at  Kensington.  In those cases
where bleeding had been used on the first day,  it was both
safe and useful to repeat it  every  day  afterwards,  during
the continuance of the fever.
   2. I preferred bleeding in the exacerbation of the fever.
The remedy here was applied when the disease was in  its
greatest  force.  A single paroxysm  was like a  sudden
squall to the system, and,  unless abated by bleeding or
purging, often produced universal  disorganization.  I pre-
ferred the former to the latter  remedy in cases of great
danger,  because it was more speedy, and  more certain in
its operation,
   3. I bled in  several  instances in  the  remission of the
fever, where the pulse was  tense and corded.  It lessened
the violence of the succeeding paroxysm.
   4. I bled in all those  cases in which  the pulse was  pre-
ternaturally slow, provided it was  tense.  Mr.  Benj.  W.
Morris,  Mr. Thomas  Warton,  jun. and Mr.  Wm. San-
som, all owe their lives probably to their having been bled
in the above state of (the pulse.  I was led to use bleeding
in this state of the pulse,  not  only by the  theory of the
disease which I had adopted, but by the success which  had
often attended this  remedy, in a slow  and depressed stato
   VOL.  III.               i 
146              AN  ACCOUNT OF THE

of the pulse in apoplexy and pneumony.  -I had moreover
the authority of Dn Mosely in its  favour, in the yellow
fever, and of Dr. Sydenham, in his account of anew fever,
which appeared in the year 1685.   The words of the latter
physician are so apposite to the cases which  have been
mentioned, that  I hope  I  shall be  excused  for inserting
them in this place.  " All the symptoms of weakness (says
our author) proceed from nature's  being in a manner op-
pressed and overcome by the first attack of the  disease, so
as not to be able to  raise regular symptoms adequate to the
violence of the fever.   I remember to have met  with a
remarkable instance of this several  years ago, in a young
man I then attended; for though he seemed in a manner
expiring, yet the outward parts felt  so  cool,  that I could
not persuade the attendants he had a fever, which could not
disengage, and show itself clearly, because the vessels were
so full as to obstruct the motion of  the blood.   However,.
I said, that they would soon  find the fever  rise high enough
upon bleeding him.  Accordingly, after  taking away a large
quantity of blood, as violent a fever appeared as ever I met
with, and did not go off till bleeding had been used  three
or four times."*
  5. I bled in those cases in which the fever appeared in
a tertian form, provided the  pulse was full  and tense.  I
well recollect  the  surprise  with  which Mr. Van Berkel
heard this prescription from me, at a  time  when he was
able to walk  and ride out on the  intermediate days  of a
tertian fever.   The  event which followed this prescription
showed that it was not disproportioned to the violence of
his disease,  for it soon  put on such acute and  inflamma-
tory symptoms  as to  require six subsequent bleedings to
subdue it.
   6. I bled in those cases  where patients were able to walk
about, provided the pulse was the  same as has been men-
tioned under the fourth head.  I was determined as to the
propriety of bleeding in these  two supposed mild forms of
the fever, by having observed each of them,  when left to
themselves, frequently to terminate in death.
  7. I paid no regard to the dissolved  state  of the blood,
when it appeared on the first or second  day of the disease,
but repeated the bleedings afterwards in every case, where
                     * Vol. ii. p. 351. 
BILIOUS YELLOW  FEVER OF 1793.       147
 the pulse continued to indicate it.   It was common to see
 sizy blood succeed that which was dissolved.  This occur-
 red in Mr. Josiah Coates, and Mr. Samuel Powel.  Had
 I believed that this dissolved state of the  blood arose  from
 its putrefaction, I should have laid aside  my lancet as soon
 as 1 saw it; but I had  long ago parted with all ideas of
 putrefaction  in  bilious fevers.   The  refutation  of this
 doctrine was the object of one of my papers in the Medical
 Society of Edinburgh,  in the year 1767.  The dissolved
 appearance of the blood, I suppose  to be the effect of a
 certain action of the blood-vessels upon  it.   It  occurs in
 fevers which depend upon the sensible qualities  of  the air,
 and in which no putrid  or foreign matter has been intro-
 duced into the system.
   8.  The presence of petechiae  did not deter me  from
 repeating blood-letting, where the pulse retained its  fulness
 or tension. I prescribed it with success in the cases of Dr.
 Mease, and of Mrs. Gebler, in Dock-street, in  each of
 whom petechiae  had appeared.   Bleeding  was   equally
 effectual in the case  of the Rev.  Mr. Keating, at a time
 when his arms were spotted with that species of eruptions
 which I have compared to  moscheto-bites.  I had prece-
 dents in Dr. De Haen* and Dr. Sydenham,!  in favour of
 this practice.   So far from viewing these eruptions as signs
 of putrefaction, I considered them as marks of the  highest
 possible inflammatory diathesis.  They disappeared in each
 of the above cases after bleeding.
   9.  In determining the quantity of blood to be drawn,  I
 was governed by the state of  the pulse, and by the tempe-
rature of the  weather.  In the beginning of September,  I
found one or two  moderate bleedings sufficient to subdue
the fever; but in proportion as the system  rose  by the
diminution of the stimulus of heat, and the fever put on
more visible signs of inflammatory diathesis, more frequent
bleedings became necessary.   I  bled many patients twice,
and a  few three  times a  day.  I preferred frequent  and
small, to large bleedings, in the beginning of  September;
but towards the height and close of the epidemic, I saw no
inconvenience from the loss of a  pint, and  even  twenty
ounces  of blood  at a time.   I drew from many  persons

  • Ratio Mcdendi, vol. ii. p. 162.  vol. iv. p.  172.
  •; Vol. i. p. 210, and 264. 
148
AN ACCOUNT OF THE
seventy and eighty ounces in five days;  and from a few, a
much  larger  quantity.  Mr.  Gribble,  cedar-cooper, in
Front-street, lost by ten bleedings a hundred ounces of
blood;  Mr. George, a  carter in Ninth-street, lost about the
same quantity by five bleedings; and Mr. Peter Mierken,
one hundred andfourteen ounces in five days. In the last of the
above persons the quantity taken was determined by weight.
Mr.  Toy, blacksmith  near  Dock-street, was eight times
bled in the course of seven days. The quantity taken from
him  was about a hundred ounces.   The blood in all these
cases was dense, and in the last very sizy.  They were all
attended in the month of October, and chiefly by my pupil,
Mr.  Fisher;  and they were all, years afterwards, living and
healthy instances of the efficacy  of copious blood-letting,
and of the intrepidity and judgment of  their young physi-
cian. Children, and even old people, bore the loss of much
more blood in this fevjer than in common  inflammatory
fevers.   I took above thirty ounces in five bleedings,  from
a daughter of Mr. Robert Bridges, who was then in the
9th year of her age.  Even  great debility, whether natural
or brought on by previous diseases, did not, in those few
cases in which it yielded to  the  fever, deprive  it of the
uniformity of its  inflammatory character.  The following
letter from Dr. Griflitts, written  soon  after his  recovery
from a third attack of the fever,  and just before  he  went
into  the country for the re-establishment of his health, will
furnish a striking illustration of;  the truth of the above
observation.
   "I  cannot  leave town without-a parting adieu to my
kind friend,  and sincere prayers for his preservation.
   "lam sorry to find  that the use of the lancet is still so
much dreaded by too many  of our physicians; and, while
lamenting the death of  a  valuable  friend this morning, I
was  told that he was  bled  but  once during his  disease.
Now if my poor frame, reduced by previous sickness, great
anxiety, and fatigue, and a very  low diet, could bear seven
bleedings, in five days, besides  purging, and no diet but
toast and water, what shall we  say of physicians who bleed
but once ?
" October 19th, 1793."

   I have compared a paroxysm of this  fever to a sudden
squall;  but  the disease in  its  whole course was  like  a 
          BILIOUS YELLOW FEVER OF 1793.       149

tedious equinoctial gale acting upon  a ship at sea;  its de-
structive force was only to be opposed by handing every
sail, and leaving the system to float,  as it were under bare
poles.   So great was the fragility (if  I may be allowed the
expression)  of the blood-vessels,  that  it was  necessary to
unload them of their contents, in order to prevent the system
sinking from haemorrhages, or from effusions in the viscera,
particularly  the brain.
   9.  Such was the indomitable nature of the pulse, in some
patients, that it did not lose its force after numerous  and
copious bleedings.  In all such cases  I considered the dimi-
nution of its frequency, and the absence of a vomiting, as
signals to lay aside the lancet.   The  continuance  of  this
preternatural force in the pulse appeared to be owing to the
miasmata, which  were universally diffused in the air, acting
upon the arterial system in the same manner that it  did in
persons who were in apparent good health.
   Thus have I mentioned the principal circumstances which
were connected with blood-letting in the cure of the yellow
fever.   I shall now consider the objections that were made
to it at the time, and since the prevalence of the fever.
   It was said  that the bleeding was unnecessarily copious;
and that many had been destroyed by it. To this  I answer,
that I  did not  lose a single patient whom 1 bled seven times
or more in this fever.  As a further proof that I did  not
draw an ounce of blood too much it  will only be  necessary
to add, that  haemorrhages frequently  occurred after a third,
a  fourth,  and in  one  instance  (in  the only son  of  Mr.
William Hall) after a  sixth bleeding had been used;  and
further, that  not a  single  death occurred  from  natural
haemorrhages in the first stage of the disease.   A woman
who had been bled by my advice, awoke the night  follow-
ing in  a bath  of her  blood, which had flowed from  the
orifice in  her  arm.   The next day she was free from pain
and fever.   There were many recoveries in the  city from
similar accidents.   There were  likewise  some recoveries
from copious natural haemorrhages in the more advanced
stages  of the disease, particularly when they occurred from
the stomach and bowels.  I left  a servant  maid of Mrs.
Morris's in Walnut-street, who had discharged at least four
pounds of blood  from her stomach,  without a pulse, and
with scarcely  a symptom that encouraged a hope of her 
150
AN  ACCOUNT OF THE
 life;  but the next day I had the pleasure of finding her out
 of danger.
   It  was remarked that fainting was much less  common
 after bleeding in this fever than in  common  inflammatory
 fevers.   This circumstance was observed by Dr. Griffitts,
 as well as myself.   It has since been confirmed to me by
 three of the principal bleeders in the city, who performed
 the operation upwards of four thousand times. It occurred
 chiefly in those cases where it was used for the first time on
 the third or fourth day of the  disease.  A swelling of the
 legs,  moreover, so common after a plentiful bleeding  in
 pneumony and rheumatism, rarely succeeded the use  of
 this remedy in the yellow fever.
   2.  Many of the indispositions,  and much of the subse-
 quent weakness of persons who had been cured by copious
 blood-letting,  have  been ascribed to it.  This is so far from
 being true, that the reverse of it has occurred in many cases.
 Mr. Mierken  worked in  his sugar-house  in  good health,
 nine days after his last bleeding; and Mr. Gribble and Mr.
 George seemed to  have derived fresh  vigour from their
 evacuations.  I could mention the names of many  people
 wTho assured me their constitutions had  been  improved by
 the use of those remedies ; and I know several persons in
 whom they have  carried off habitual  complaints.   Mr.
 Richard Wells attributed his relief from a chronic rheuma-
 tism to the copious bleeding and purging which were used
 to cure him of the yellow fever; and Mr. William Young,
 the bookseller, was relieved  of a chronic pain in his side,
 by'means of the same remedies.
   3.  It was said, that blood-letting was prescribed indis-
 criminately in all cases,  without any regard to age, consti-
 tution, or the force of the disease.  This is not true, as far
 as it relates to  my practice. In my prescriptions for patients
 whom I was unable to visit, I advised  them, when  they
 were  incapable of judging of the state of the  pulse, to be
 guided in the  use of bleeding, by the degrees of pain  thev
 felt, particularly in  the head;  and  I seldom advised it for
 the first time, after the second or third day of the disease.
  In pneumonies which  affect  whole neighbourhoods  in
the spring Of the year, bleeding is the universal  remedy.
 Why should it not be equally  so,  in a  fever which is of a
 more uniform  inflammatory nature, and  which tends more 
          BILIOUS YELLOW FEVER OF 1793.       151

rapidly to effusions, in parts of the body much more vital
than the lungs?
  I have  before remarked, that the debility which occurs
in the beginning of the yellow fever, arises from a depress-
ed state of the system.  The debility in the plague is of the
same nature.  It has long been known that debility from
the sudden abstraction of stimuli is to be removed by the
gradual application of stimuli, but it has been less observ-
ed, that the excess of stimulus in the system is best remov-
ed in a gradual manner, and that too  in proportion to the
degrees of depression, which exist in the system.
   This principle in the animal economy has been acknow-
ledged  by  the practice of occasionally  stopping the dis-
charge of water from  a canula in tapping, and  of blood
from a vein, in order to prevent fainting.
   Child-birth induces fainting, and sometimes death,  only
by the sudden abstraction of the stimulus of distention and
pain.
   In all those cases where purging or bleeding have  pro-
duced death in the yellow fever or plague, when they have
been used on the first  or second day of those  diseases,  1
suspect that it was occasioned by  the quantity of the stimu-
lus abstracted being disproportioned to the degrees of de-
pression in the  system.  The following facts will I. hope
throw light upon this subject.
   1.  Dr. Hodges informs us, that "although blood could
not be drawn in the plague,  even in the smallest  quantity
vvithout danger,  yet a hundred times the quantity of fluids
was discharged  in pus from buboes  without inconveni-
ence."*
   2. Pareus, after condemning bleeding in the plague,  im
mediately adds an account of a patient, who was saved by
an haemorrhage from the nose, which continued two days.t
   3.  I have before taken notice that bleeding proved fatal
in three cases in the yellow fever,  in the month of August;
but at  that time I saw one, and heard of another case,  in
which death seemed to have been prevented by a  bleeding
at the nose.  Perhaps the uniform good effects which were
observed  to follow  a  spontaneous haemorrhage  from an
orifice in the arm, arose wholly from the gradual manner
• Page 114.
* Skcnkms, lib. vi. p. 881. 
152
AN  ACCOUNT OF THE
in which the stimulus of the blood was  in this way ab-
stracted from the body.  Dr.  Williams relates  a  case  of
the recovery of a gentleman  from the yellow  fever,  by
means of small haemorrhages,  which continued three days,
from wounds in his shoulders made by being cupped.  He
likewise  mentions several other recoveries  by haemorrhages
from the nose,  after  " a vomiting of black humours and a
hiccup had taken place."*
  4.  There is a disease in North-Carolina, known among
the common people  by the name of the  " pleurisy in the
head."  It occurs in the winter, after a sickly autumn, and
seems to be an evanescent symptom of a  bilious remitting
fever.   The cure of it has been attempted by bleeding, in
the common way, but generally without  success.   It has,
however, yielded to this remedy in another form,  that is,
to the discharge of a few  ounces of blood obtained by
thrusting a piece of quill up the nose.
  5.  Riverius describes a pestilential fever which prevailed
at Montpellier, in the year 1623, which carried  off one half
of all who were affected by it.f   After many unsuccessful
attempts to cure it, this judicious physician prescribed the
loss of two or three ounces of blood.   The pulse rose with
this small evacuation.  Three or four hours afterwards he
drew six ounces of blood from his patients, and with the
same good effect.   The next day he gave a purge, which,
he  says, rescued his patients from the grave.    All whom
he  treated in > this manner recovered.   The whole history
of this epidemic is highly interesting, from its agreeing
with our late epidemic in so many of its symptoms, more
especially as they appeared in the different states of the
pulse.
   An old and  intelligent  citizen of Philadelphia,  who  re-
members the yellow fever of 1741, says  that when it first
made its appearance, bleeding was attended with fatal con-
sequences.   It was laid  aside afterwards,  and  the disease
prevailed with great mortality until it was checked by the
cold weather.   Had blood been drawn in  the manner men-
tioned by Riverius, or had it been drawn in the  usual way,
after  the abstraction of the stimulus of  heat by  the cool
weather, the disease might probably have been subdued,
* Essay on the Bilious or Yellow Fever of Jamaica, p. 40.
~ Be Febre Pestilenti, vol. ii. p. 145, 146, and 147. 
BILIOUS YELLOW FEVER OF  1793.        153
and the remedy of blood-letting thereby  have recovered
its character.
   Dr. Hodges has another remark, in his account of the
plague in London in the year 1665, which is still more to
our purpose than the one which I have quoted  from it up-
on this  subject.  He says that " bleeding, as a preventive
of the plague, was only safe and useful when the blood was
drawn by a small orifice, and a small quantity taken at dif-
ferent times."*
   I have remarked, in the history of this fever,  that it was
often cured on the first or second day  by a copious sweat.
The Rev. Mr. Ustick was one among many whom I could
mention, who were saved from a violent attack  of the fever
by this evacuation.   It  would  be  absurd to suppose that
the miasmata which produced the disease were  discharged
in this manner from the body.  The sweat seemed to cure
the fever only by lessening the quantity of the  fluids, and
thus gradually  removing the  depression of the system.
The profuse sweats  which sometimes cure the plague,  as
well as the disease, which is brought on by the bite of poi-
sonous snakes, seem to act in the same way.
   The system, in certain states of malignant fever, resem-
bles a man struggling beneath a  load  of two  hundred
weight,  who is able to lift but one  hundred and seventy-
five.  In order to assist him it will be to no purpose to at-
tempt to infuse additional vigour into his muscles by the
use of a whip or of strong drink. Every exertion will serve
only to waste his strength.  In this  situation (supposing it
impossible to  divide the weight which confines  him to the
ground)  let the pockets of this man be emptied of their
contents, and  let him be stripped of so much of his cloth-
ing as  to reduce  his  weight five  and twenty or thirty
pounds.   In  this situation he will rise from the ground ;
but if the weights be abstracted suddenly, while he  is in
an act of exertion,  he will rise with  a spring that  will en-
danger a  second fall, and probably produce a  temporary-
convulsion in his system.  By abstracting the weights from
his body more gradually, he will rise by degrees from the
ground, and the system will accommodate itself in  such
a manner to  the diminution of its pressure, as  to resume

                       *  Page 209.        4
   VOL.  III.               U 
154
AN ACCOUNT OF THE
its erect form, without the least deviation from the natural
order of its appearance and motions.
  It has been said that the  stimulating remedies of bark,
wine, and the cold bath, were proper in our late epidemic
in August,  and in the beginning of September, but that
they were improper  afterwards.  If  my  theory be just,
they were more improper in August and the beginning  of
September, than they were after the disease put on the out-
ward and common signs of inflammatory diathesis.   The
reason why a few strong purges cured the disease  at its
first appearance, was, because they abstracted in  a gradual
manner some of the immense portion of stimulus  under
which the arterial system laboured, and thus gradually re-
lieved it from its low and weakening degrees of depression.
  Bleeding was fatal in these cases, probably because it re-
moved this depression in too sudden a manner.
  The principle of the gradual abstraction, as well as of the
gradual application of stimuli to the body, opens  a wide
field  for the improvement of medicine.  Perhaps  all the
discoveries of future ages will consist more in  a new appli-
cation of established principles, and in new modes of exhi-
biting old medicines,  than in the discovery of new theories,
or of new articles of the materia medica.
  The reasons which induced me to prescribe  purging and
bleeding, in so liberal a manner, naturally led me to recom-
mend cool and fresh air to my patients.  The good effects
of it were obvious in almost every case in which  it was
applied.   It was equally proper whether the arterial system
was depressed, or wrhether  it discovered,  in  the pulse, a
high degree of morbid excitement.  Dr. Griffitts furnished
a remarkable instance of the influence of cool air upon the
fever.   Upon my visiting him, on the morning  of the 8th
of October,  I found his pulse so full and tense as to indi-
cate bleeding, but after sitting a few minutes  by his bed-
side, I perceived that the windows of his room had  been
shut in the night by his nurse,  on account of  the coldness
of the night air.   I desired that they might be opened.  In
ten minutes afterwards the doctor's pulse became so much
slower and weaker  that I advised the postponement of the
bleeding,  and recommended a purge instead  of it.   The
bleeding notwithstanding became necessary, and was used
with great advantage in the afternoon of the same day. 
          • ILI0US YELLOW FEVER OF 1793.       155

  The cool air was improper only  in those cases where a
chilliness attended the disease.
  For the same reason that I advised cool air, I directed
my patients to use cold drinks.   They consisted of lemon-
ade, tamarind, jelly and raw apple water, toast and  water,
and of weak balm, and camomile tea.  The subacid drinks
were preferred in most cases, as being not only most agree-
able to the taste,  but because they tended  to compose the
stomach.   All these drinks were taken in the early stage of
the disease.   Towards the close of it,  I permitted the  use
of porter and water, weak punch, and when the stomach
would bear it, weak wine-whey.
  I forbade  all cordial and stimulating food in the active
state of the arterial system.  The less my patients ate, of
even the mildest vegetable food,  the sooner they recovered.
Weak coffee, which (as I have formerly remarked) was al-
most universally agreeable, and weak tea were always inof-
fensive.  As the action of the pulse diminished, I  indulged
my patients with weak chocolate; also with milk,  to which
roasted apples or minced peaches, and (where diey were not
to be had) bread or  Indian mush were added.
   Towards the crisis, I advised the drinking of weak chick-
en, .veal, or  mutton broth, and  after the crisis had  taken
place,  I permitted mild animal food to be eaten in a small
quantity, and to be increased according to the waste of the
excitability of the system.  This strict abstinence which I
imposed upon my patients did not escape obloquy ; but the
benefits they  derived from it, and the ill effects which arose
in many cases from a  contrary regimen, satisfied  me that
it was proper in every case in which it was prescribed.
  Cold water was a most agreeable  and powerful remedy
in this disease.   I directed it to be applied  by means of
napkins to the head, and to be injected into the bowels by
way of clyster.   It gave the  same ease to both,  when in
pain, which opium gives to pain from other causes.  I like-
wise advised  the washing of the face and hands, and some-
times the feet, with cold water, and always with advantage.
It was by suffering the body to lie  for some time  in  a bed
of cold water, that the inhabitants of the island of Massuah
cured the most violent  bilious  fevers.*   When applied
* Bruce'b Travels. 
 156             AN ACCOUNT  OF THE

 in this way,  it gradually abstracts the heat from the body,
 and thereby  lessens the action of the system.  It differs as
 much in its effects upon the body from the cold bath, as
 rest in a cold room differs from exercise in the cold and
 open air.
   I was first led to the practice of the partial application of
 cold water to the body,  in fevers of too much force in the
 arterial system,  by observing its good effects in active
 haemorrhages, and by recollecting the effects of a partial
 application of warm water to the feet, in fevers of an oppo-
 site character.   Cold water when applied to the feet as cer-
 tainly reduces the pulse in  force and frequency,  as warm
 water, applied in the same way,  produces contrary effects
 upon it.  In an experiment which was made at my request,
 by one of my pupils, by placing his feet in cold pump wa-
 ter for a few minutes,  the pulse was reduced 24 strokes in
 a minute, and became so small as hardly to be perceptible.
   But this effect of cold water,  in reducing the frequency
 of the pulse, is not uniform.   In weak  and irritable habits,
 it increases its frequency.  This has been fully proved by
 a number of experiments, made by  my former pupil,  Dr.
 Stock, of Bristol, in England, and published in his " Me-
 dical Collections of the Effects of Cold, as a  Remedy in
 certain Diseases."*
   In the use of the remedies which were necessary to over-
 come the inflammatory action of the system,  I was  obliged
 to reduce it below its natural point of  excitement.  In the
 present  imperfect  state of our  knowledge in medicine,
 perhaps no disease of too much action can be  cured with-
 out it.
  Besides the remedies which have been mentioned, I was
 led to employ another of great efficacy.  I had observed a
favourable  issue of the  fever, in every case in which a
spontaneous discharge took place  from the salivary glands.
I had observed  further,  that all such of my patients (one
excepted) as were salivated by the mercurial purges reco-
vered in a few days.  This  early suggested an idea to me
that  the calomel might be applied to other purposes  than
the discharging  of  bile from  the  bowels.   I ascribed its
salutary effects, when it salivated in the first stage of the
' Page 185. 
         BILIOUS YELLOW FEVER  OF  1793.        157

disease, to the excitement of inflammation and effusion in
the throat, diverting them from more vital parts of the body.
In the second stage of the disease, I was led to prescribe it
as a stimulant, and, with a view of obtaining this operation
from it, I aimed at exciting a salivation, as speedily as pos-
sible, in all cases. Two precedents encouraged me to make
trial of this remedy.
   In die month of October, 1789, I attended a  gentleman
in a bilious fever, which  ended in many of the  symptoms
of a typhus mitior.   In the lowest state of his fever, he
complained of a pain in his right side,  for which 1 ordered
half an ounce of mercurial ointment to be rubbed on the
part affected.   The next  day,  he complained  of a sore
mouth, and, in the course of four and twenty hours, he was
in a moderate salivation.   From this time his pulse became
full and  slow, and his skin moist;  his sleep and appetite
suddenly returned, and in a day or two he was out of
danger.  The second precedent for salivation in  a fever,
which occurred to me,  was in  Dr. Haller's short  account
of the  works of Dr. Cramer.*  The practice was moreover
justified, in point of  safety, as  well as the probability of
success,  by the accounts which Dr. Clark has lately given
of the  effects of a salivation in the dysentery.f   I began by
prescribing the calomel in small doses, at short intervals,
and afterwards I directed large quantities of the ointment to
be  rubbed  upon the limbs.  The effects of it, in every
case in which  it affected the mouth, were salutary.   Dr.
Woodhouse improved upon my method of exciting the sa-
livation, by nibbing the gums with calomel, in the manner
directed by Mr. Clare. It was more speedy in its operation
in this way than in any other, and equally  effectual.  Seve-
ral persons appeared to be benefitted by the mercury intro-
duced  into the system in the form of an ointment, where it
did not produce a salivation.  Among these, were the Rev.
Dr. Blackwell, and Mr. John Davis.
  Soon after the above account was written of the good ef-
fects of a mercurial salivation in this fever, I had great sa-
tisfaction in discovering  that it had been prescribed with
equal,  and  even greater success, by Dr. Wade in  Bengal,
in the  year 1791, and by Dr. Chisholm  in die island of

     •  Bibliotbeca Medicinx Practice, vol. iii. p. 491.
     +  Diseases of long- Voyages to Hot Climates, vol. \'< p. 334. 
158
AN  ACCOUNT OF THE
Granada, in the cure of bilious yellow fevers.* Dr. Wade
did not lose one,  and Dr. Chisholm lost only one out of
forty-eight patients in whom the mercury affected the sali-
vary glands.   The latter gave 150 grains of calomel,  and
applied the strongest mercurial ointment below the groin of
each side, in some cases.   He adds further, that not a sin-
gle instance of a  relapse occurred, where the disease was
cured by salivation.
  After the reduction  of the system, blisters were applied
with great advantage to every part of the body.  They did
most service when they were  applied to the crown of the
head.  I did not see a single case, in which a mortification
followed the sore, which was created by a blister.
  Brandy and water, or porter and water, when agreeable
to the stomach, with now and then a cup  of chicken broth,
were the drinks I prescribed to assist in restoring  the tone
of the system.
  In  some cases  I directed  the limbs to  be wrapped in
flannels dipped in warm spirits,  and cataplasms of bruised
garlic to be applied to the feet.  But my principal depend-
ence, next to the use of mercurial medicines,  for exciting
a healthy action in the arterial system, was upon mild and
gently stimulating food.   This  consisted of rich broths,
the flesh of poultry, oysters, thick gruel, mush and milk,
and chocolate.  I directed my patients to  eat or drink a
portion of some of the above articles of diet every hour or
two during the day, and in cases of great  debility, from an
exhausted state of the system, I advised their being waked
for the same purpose two or three times in the night.  The
appetite frequently craved more savoury articles  of  food,
such as beef-steaks and sausages;  but they were permitted
with great caution,  and never till the system had been pre-
pared for them by a less stimulating diet.
  There were several symptoms which were very distress-
ing in this disease, and which required a specific treatment.
  For the vomiting, with a burning sensation in the sto-
mach,  which came on about the fifth day,  I found no
remedy equal to a table spoonful of sweet milk, taken every
hour, or to small draughts  of milk and water.  I was led
to prescribe this simple medicine from having heard,  from
* Medical Commentaries, vol. xviii. p. 209, 288. 
          BILIOUS YELLOW FEVER OF  1793.        159

a West-India practitioner,  and afterwards  read,  in Dr.
Hume's account of the yellow fever, encomiums upon the
milk of the  cocoa-nut  for  this  troublesome  symptom.
Where sweet milk failed of giving relief, I prescribed small
doses of sweet oil, and in some cases a mixture  of equal
parts of milk, sweet  oil, and  molasses.  They  were all
intended to dilute or blunt the acrimony  of  the humours,
which  were  either effused  or  generated in the stomach.
Where they all failed of checking the vomiting, I prescrib-
ed weak camomile tea, or porter, or cider and water, with
advantage.   In some of my patients the stomach rejected
all the mixtures and liquors which have  been mentioned.
In such cases I directed the stomach to be left to itself for
a few hours, after  which it sometimes  received and retain-
ed the drinks that it had before rejected, provided they were
administered in a small quantity at a time.
   The vomiting  was sometimes stopped by a blister ap-
plied to the external region of the stomach.
   A mixture of liquid  laudanum  and  sweet  oil, applied
 to the same place, gave relief where the stomach was af-
 fected by pain only, without a vomiting.
   I have formerly mentioned that a distressing pain often
 seized the lower part of the bowels.   I  was early taught
 that laudanum was not a proper remedy for it.   It yielded
 in almost every case to two or three emollient clysters, or
 to the loss of a few ounces of blood.
   The convalescence from this fever was in general rapid,
 but in some cases it  was  very slow.  I was more than
 usually struck by  the great resemblance which the  system
 in the convalescence from this fever bore to  the state of the
 body and mind in old  age.   It appeared,   1. In the great
 weakness of the  body, more especially of  the limbs.  2.
 In uncommon depression of mind,  and in a great apitudt
 to shed tears.  3.  In the absence  or  short  continuance of
 sleep.  4. In the frequent occurrence  of appetite,  and, in
 some cases,  in its  inordinate degrees.  And 5. In the loss
 of the hair of the  head, or in its being suddenly changed
 in some cases to a gray colour.
   Pure air, gentle exercise, and agreeable society removed
 the debility  both of body and  mind of this  premature and
 temporary old age.  I met with a few  cases, in which the
 yellow colour continued for several weeks after the patient's 
160
AN ACCOUNT  OF THE
recovery from all the other symptoms of the fever. It was
removed most speedily and effectually by two or three mo-
derate doses of Calomel and rheubarb.
   A feeble and irregular intermittent was very troublesome
in some people,  after  an  acute  attack  of the lever.  It
yielded gradually to camomile or snake-root tea and coun-
try air.
   In a publication,  dated the 16th of September, I recom-
mended a diet of milk and vegetables, and cooling purges
to be taken once or twice a week, to the citizens of Phila-
delphia.  This advice was the result of the  tiieory of the
disease I had adopted, and  of the successful practice which
had arisen from it.  In my intercourse with  my fellow-
citizens, I advised  this regimen to be  regulated by the de-
grees of fatigue and foul air to which they were exposed.
I likewise advised moderate blood-letting to all such per-
sons as were of a  plethoric habit.   To men whose minds
were influenced by  the  publications in favour of bark and
wine, and who were unable at that time to grasp the extent
and force of the remote cause of this terrible fever, the
idea  of dieting, purging, or  bleeding  the  inhabitants of a
whole village or city appeared to be  extravagant and ab-
surd :  but I had not only the analogy of the regimen made
use of to prepare the body for the  small-pox, but many
precedents in favour of the advice.   Dr. Haller has  given
extracts from  the  histories of two  plagues, in which the
action of the miasmata  was prevented or mitigated by
bleeding.*  Dr. Hodges confirms the utility  of the  same
practice.  The benefits of  low diet, as a preventive of die
plague, were establised  by  many authors,  long before they
received the testimony of the benevolent Mr. Howard in
their favour.  Socrates  in Athens, and Justinian in Con-
stantinople,  were preserved, by means of their abstemious
modes of living, from the plagues which occasionally rava-
ged those cities. By means of the low diet, gentle physic,
and occasional bleedings,  which I thus publickly recom-
mended, the disease was prevented  in many instances, or
rendered mild where it  was taken.   But my efforts to pre-
vent the disease in my fellow-citizens did not end here.
I advised them, not only in the public-papers,  but in my
intercourse  with them,  to  avoid heat, cold, labour, and
        * Bibliotheca Msdicin* Practice, vol. ii. p. 93, and 387. 
BILIOUS YELLOW  FEVER OF 1793.      161
every thing else that could excite the  miasmata (which I
knew to be present  in all their bodies) into action.  I for-
got, upon this occasion, the usual laws which  regulate the
intercourse of man with man.  In  the streets, and, upon
the public roads in  my  excursions into the neighbourhood
of die city, I cautioned  many  persons, whom I saw walk-
ing or riding in an unsafe manner, of the danger to which
they exposed themselves ; and thereby, I hope, prevented
an attack of die disease in many people.
   It was from a conviction  of the utility of low diet, gentle
evacuations, and  of carefully   shunning all  the  exciting
causes which I have mentioned,  that  I concealed, in no
instance, from my patients the name of their disease. This
plainness, which was blamed by  weak  people,  produced
strict  obedience to  my  directions, and  thereby restrained
the progress  of the fever in many families, or rendered it,
when taken,  as mild as inoculation does  the small-pox.
The opposite conduct of several physicians, by preventing
the above precautions, increased the mortality of the dis-
ease,  and, in some  instances, contributed to the extinction
of whole families.
   I proceed now to make a few remarks upon the remedies
recommended by Doctors  Kuhn and Stevens, and bv  the
French physicians.   The former were bark,  wine,  lauda-
num, spices,  the elixir of vitriol, and the cold bath.
   In  every case in  which I prescribed bark, it was offen-
sive to the stomach.   In several tertians which attended
the convalescence  from a common attack  of  the fever, I
found it always unsuccessful, and once hurtful. Mr.  Wil-
ling took it for several  weeks  without effect.  About half
a pint of  a weak decoction  of  the bark  produced,  in  Mr.
Samuel Meredith, a paroxysm of the fever, so violent as
to require the loss of ten ounces of blood to moderate it.
Dr. Annan informed me that he was forced to  bleed one of
his patients twice, after having given him a small quantity
of bark, to hasten his convalescence.
   It was not in this epidemic only that the bark was hurt-
ful.   Baron Humboldt informed me that Dr.  Comoto had
assured him, it hastened death in every case  in which it
was given in the yellow fever of Vera  Cruz.  If, in any
instance, it was inoffensive, or did  service, in our fever, I
suspect it must have acted upon the bowels as a purge.
     VOL. III.              x 
162
AN ACCOUNT  OF  THE
 Dr. Sydenham says the  bark cured  intermittents by this
evacuation ;* and Mr. Bruce says it  operated in the same
 way, when it cured the bilious fevers  at Massuah.
   Wine was nearly as disagreeable  as the  bark  to the
 stomach, and equally hurtful. I tried it  in every form, and
 of every quality.  But  without success.   It was either
 rejected by the stomach, or produced  in it a burning sensa-
 tion.  I should suspect that  I  had been mistaken  in my
 complaints  against wine, had  I not since met  with an
 account in Shenkius of its having destroyed all who took
 it in the famous Hungarian fever which prevailed, with
 great mortality, over nearly every country in Europe, about
 the middle of the 16th century.f Dr. Wade declares wine
 to be " ill adapted to the fevers of Bengal, where the treat-
 ment has been proper in other respects."
    Laudanum has been  called by Dr. Mosely  "a fatal
 medicine" in the yellow fever.  In one of my  patients, who
 took only fifteen drops of it, without my advice, to ease a
 pain in his bowels, it produced a delirium, and  death in a
 few hours.   I was much gratified in discovering that my
 practice, with respect to the use of opium in this fever,
 accorded with Dr. Wade's  in the fever of Bengal. He tells
 us, "that  it was mischievous in almost  every instance,
 even in combination with antimonials."
    The spices were hurtful  in  the first  stage of the fever,
 and, when sufficient evacuations had  been used, they  were
 seldom necessary in its second.
    The elixir of vitriol  was, in  general,  offensive to the
 stomach.
    The cold bath was useful in those cases where its sedative
 prevailed over  its stimulating effects.   But this could not
 often happen, from  the  suddenness and force, with which
 the water was  thrown upon the body.   In two cases  in
 which I prescribed  it, it produced  a gentle sweat, but it
 did not save  life.  In a third it removed a delirium, and
 reduced the pulse for a few minutes, in frequency and force,
 but this patient died.  The recommendation  of it indiscri-
 minately,  in  all  cases, was  extremely  improper.   In
 that  chilliness  and tendency  to fainting  upon the least

   * Vol. i. p. 440.
   f Omnes qui  vini potione non  absiinuerunt, interiere, adeo ut^summa spes
 aalvationis in vini abstifientia collocata videter. Lib. vi. p, 847. 
BILIOUS YELLOW FEVER OF 1793.       16*3
motion, which attended the disease in some patients, it was
an unsafe remedy.   I heard of a woman who was seized
with delirium immediately after using it, from which she
never recovered; and of a man who died a few  minutes
after he came out of a bathing tub.  Had this remedy been
the exclusive antidote to the yellow  fever, the mortality of
the disease would have been but  little  checked by it.
Thousands must have perished from the want of means to
procure tubs, and  of a suitable  number of attendants to
apply die water, and to lift the patient in and out of bed.
The reason of our citizens  ran  before the  learning of the
friends of this, remedy, and long before  it  was abandoned
by the physicians, it was rejected as  useless, or not attempt-
ed, because impracticable, by the good sense of the city.
It is  to be lamented that the remedy  of cold water has
suffered in its  character by the manner in which it  was
advised.  In fevers of too much action, it reduces the mor-
bid excitement of the blood-vessels, provided it be applied
without force, and for a considerable time, to the body. It
is in the jail fever, and in the second stage  of the yellow fever,
only, in which  its  stimulant  and tonic powers are proper.
Dr. Jackson establishes this mode of using it, by informing
us, that when it did service, it " gave vigour and tone" to
the system.*
   A mode of practice which  I formerly mentioned in this
fever, consisted of a union  of the evacuating and tonic
remedies.   The physicians who adopted this mode gave
calomel by itself, in, small doses, on the  first or second day
of the fever, bled once or twice, in a sparing  manner,  and
gave the bark,  wine, and laudanum, in large quantities,
upon the first appearance of a remission.  After they began
the use of these remedies purging was  omitted, or, if the
bowels were* moved, it was only by means of gentle  clys-
ters.   This practice, I shall say  hereafter,  was not much
more successful than that which was recommended by Dr.
Kuhn and Dr. Stevens.   It resembled throwing water and
oil at the same time upon a fire, in order to extinguish it.
   The  French  remedies were  nitre and cremor tartar, in
small doses, centuary tea, camphor,  and several other warm
medicines ; subacid drinks, taken in large quantities,  the.
warm bath, and moderate bleeding.
                    * Fevers of Jamaica. 
 164             AN ACCOUNT OF THE

   After what has been said it must be obvious to the reader,
 that the nitre and cremor tartar, in  small  doses, could do
 no good,  and that camphor, and all cordial medicines must
 have done harm.  The diluting subacid drinks,  which the
 French physicians gave in  large quantities were useful  in
 diluting and blunting the acrimony of the bile,  and to this
 remedy, assisted by occasional bleeding, I ascribe most of
 the cures which were performed by those physicians.
   Those  few persons in whom the warm  bath produced
 copious and universal sweats recovered, but, in nearly  all
 tile cases  which came under my notice, it did harm.
   I come now to inquire into the comparative success of all
 the different modes of practice which have been mentioned.
   I have already said that ten out of thirteen patients whom I
 treated with bark, wine, and laudanum, and that three out of
 four, in whom I added the cold bath to those remedies,
 died.   Dr. Pennington informed me, that he had lost  all
 the patients (six in number) to whom  he had  given the
 above   medicines.  Dr. Johnson assured me,  with great
 concern, abcut two weeks before he died, that he had not
 recovered a single patient by them.  Whole families were
 swept  off where these medicines were used.  But  further,
 most of those persons who received the seeds of the fever
 in  the city, and sickened in the country, or in  the neigh-
 bouring towns,  and who were treated with tonic remedies
 died.   There was not a single cure performed by them  in
 New-York, where they were used in several sporadic cases
 with every possible advantage.   But  why do I multiply
 proofs of their deadly effects ?  The clamours of hundreds
 whose  relations  had perished  by them,  and the fears  of
 others,  compelled those physicians who were most attached
 to them to lay them* aside, or to prepare the  way for them
 (as it was called) by purging and bleeding.   The bathing
 tub soon shared a w orse fate than  bark,  w ine, and  lauda-
 num, and, lonjj before the disease disappeared, it was dis-
 carded by all the physicians in the city.
   In answrer to  these facts  we are told, that Mr.  Hamilton
 and his family were cured by Dr. Stevens' remedies,  and
that Dr. Kuhn  had  administered them  with success  in
 several instances.
  Upon these  cures  I shall insert the following  judicious
remarks from  Dr. Sydenham.  " Success (says the doctor) 
         BILIOUS YELLOW  FEVER  OF 1793.       165

is not a sufficient proof of the excellency of a method of
cure in acute diseases, since some are recovered by the
imprudent  procedure of  old w.omen; but  it is further
required, that the distemper should be easily cured, and
yield conformably to its own  nature."*  And  again, speak-
ing of the cure of the new fever of 1685, this  incomparable
physician observes,  " If it be objected  that this fever fre-
quently yields to a  quite  contrary method to that  which I
have laid down,  I answer, that the  cure of a disease by a
method which is attended with success only now and then,
in a few  instances,  differs extremely  from  that  practical
method, the efficacy whereof appears both from its recover-
ing greater  numbers, and all the  practical phenomena
happening in the cure."f
   Far be it from me to deny that the depression of the system
may not be overcome by  such  stimuli as are more power-
ful than those which occasion it. This has sometimes been
demonstrated by the efficacy  of bark, wine, and laudanum,
in the confluent and petechial  small-pox ; but  even this state
of that disease  yields more  easily to blood-letting, or to
plentiful evacuations from the stomach and bowels, on the
first or second day of the  eruptive fever. This I have often
proved, by giving a large dose of tartar emetic and calomel,
as soon  as I was satisfied  from circumstances,  that my
patient was infected with the small-pox.   But the depres-
sion  produced by  the  yellow fever  appears to be  much
greater than diat  which  occurs  in  the small-pox,  and
hence it  more  uniformly resisted the most powerful tonic
remedies.
   In  one of my publications  during the prevalence  of the
fever I asserted, that the remedies of  which I have given a
history cured a greater proportion than ninety-nine out of a
hundred,  of all  who applied  to me on  the first day of the
disease, before the  15th day  of September.   I regret that
it  is not in my power to furnish a list of them, for a majo-
rity of them were poor  people, whose names are  still un-
known to  me.   I  was  not  singular  in  this successful
practice  in the  first appearance of the disease.  Dr. Pen-
nington assured me on his death bed, that he had  not  lost
one, out of forty-eight patients whom he had  treated agree-
ably  to the principles and practice I had recommended.
     • Vol. ii. p. 254.                       + Vol. ii. p. 354 
166             AN ACCOUNT OF THE

Dr. Griffitts triumphed  over the disease in every part of
the city, by the use of what were called the new remedies.
My former pupils spread, by their success, the reputation
of purging and bleeding, wherever they were called. Unhap-
pily the pleasure we derived from this success in the treat-
ment of die disease, was of short duration. Many circum-
stances contributed to lessen it, and to revive the  mortality
of the fever.  I shall briefly enumerate them.
  1. The distraction produced in the public mind, by the
recommendation of remedies, the opposites in every respect
of purging and bleeding.
  2. The opinion which had been  published by several
physicians, and  inculcated by others,  that we had  other
fevers  in the city besides the yellow fever.  This  produced
a delay in many people  in sending  for a physician, or in
taking medicines, for two or three days, from a belief that
they had nothing but a cold, or  a common fever.  Some
people were so  much deceived  by this opinion, that they
refused to send for physicians, lest they should be infected
by them with the yellow fever.  In  most of the  cases in
which  these delays took place, the disease proved mortal.
  To  obviate a suspicion that I have laid more stress upon
the fatal influence of this  error than is just,  I  shall here
insert an extract of a letter I received from Mr. John Con-
nelly, one  of the city committee, who  frequently left his
brethren in the city hall,  and spent many hours in visiting
and prescribing for the sick.   " The publications (says he)
of some physicians, that there were but few persons infected
with the yellow fever, and that many were  ill with colds
and common remitting and fall fevers, proved fatal to almost
every family which was credulous enough to believe them.
That opinion slew its hundreds if not its thousands, many of
whom  did not send for a physician until they were  in the last
stage of the disorder, and beyond the power of medicine."
  3. The  interference  of  the  friends  of the  stimulating
system, in dissuading patients from submitting to  sufficient
evacuations.
  4. The deceptions which were practised by some patients
upon their physicians, in their reports of the quantity of
blood they had lost,  or  of the quality and number of their
evacuations by stool.
  5. The impracticability of procuring bleeders as soon as 
         BILIOUS  YELLOW FEVElt OF  1793.       167

bleeding was prescribed.  Life in this disease, as in the
apoplexy, frequently turned upon that operation being per-
formed  within  an hour.  It was often delayed, from the
want of a bleeder, one or two days.
  6. The inability of physicians,  from the number of their
patients, and from frequent indisposition,  to visit the sick,
at such times as was necessary to watch the changes in their
disease.
  7.  The great accumulation and concentration of the mi-
asmata  in sick rooms,  from the continuance of the disease
in the city, whereby the system was exposed to a constant
stimulus, and the effect of the evacuations was thus de-
feated.
  8. The want of skill or fidelity in nurses to administer
the medicines properly;  to persuade patients to drink fre-
quently ; also to supply them with food or cordial drinks
when required in the night.
  9. The great degrees of debility induced in the  systems
of  many of the people who were affected by the disease,
from fatigue in attending their relations or friends.
   10. The universal depression of mind, amounting in some
instances to despair, which affected many people.  What
medicine could act upon a patient who awoke in the night,
and saw through  the broken and  faint light of a candle, no
human  creature, but a black nurse,  perhaps asleep  in a dis-
tant corner of the room; and who heard no noise,  but that
of a hearse conveying, perhaps,  a neighbour or a friend to
the grave ?  The state of mind under which many  were af-
fected by the disease, is so well described by the Rev. Dr.
Smith,  in the case of his wife, in a letter I received from
him in my sick room, two days after her death, that I hope
I shall be excused for inserting an extract  from it. It forms
a part of the history of the disease.  The letter was written
in answer to a short note of condolence which I sent to the
doctor  immediately after hearing of Mrs. Smith's death.
After some pathetic expressions  of grief, he adds, " The
scene of her funeral, and some preceding circumstances,
can never depart from my mind.  On her return from a vi-
sit to our daughter, whom we had been striving to console
on  the death of Mrs. Keppele, who was long familiar and
dear to both,  my dear wife,  passing the burying-groUnd
gate, led me into the ground, viewed the graves of her two 
168             AN  ACCOUNT OF THE

children, called  the  old grave-digger, marked a spot for
herself as close  as possible to them  and the grave of Dr.
Phineas Bond, whose memory she adored.   Then, by the
side of the spot she had chosen, we found room and chose
mine, pledging ourselves to each other,  and directing the
grave-digger, that this should be  the order of our inter-
ment.   We returned to our house.  Night approached.
I hoped my dear wife had gone to rest, as she had chosen,
since  her return from nursing her daughter, to sleep in a
chamber by herself,  through fear  of infecting her grand-
child  and me.   But  it seems  she closed  not her eyes;
sitting with them fixed through her  chamber window  on
Mrs.  Keppele's house, till  about midnight  she saw her
hearse,  and followed it with her eyTes as far as it could be
seen.   Two days afterwards Mrs. Rodgers,  her next only
surviving intimate friend, was carried past her window, and
by no persuasion could I draw her from thence, nor stop
her sympathetic  foreboding tears, so long as her eyes could
follow the funeral, which was through two squares,  from
Fourth  to Second street,  where the hearse  disappeared."
The doctor proceeds in describing the distress of his wife.
But pointed as his expressions are, they do not convey the
gloomy state of her mind with  so much force as she has
done  it herself in two letters to her niece, Mrs. Cadwalla-
der, who was then in the country.  The one was dated the
9th,  the other the 11th of October.  I  shall  insert a few
extracts from each of them.
  October 9th.   "It is  not  possible for me to pass the
streets without walking in a line with the dead, passing in-
fected houses,  and looking into  open graves.   This has
been  the case for many weeks."   " I don't know what to
write; my head is gone, and my heart  is torn to pieces."
" I entreat you to have no fears on my account.   I am in
the hands  of a  just and merciful God, and his will  be
done."
  October 11th.  " Don't wonder that I am so low to-day.
My heart is sunk down within me."
  The next day this excellent woman sickened,  and died
on the 19th of the same month.
  If in a person  possessed naturally of uncommon equani-
mity and fortitude, the distresses of our city produced such
dejection of spirits, what must have been their effect upon 
BILIOUS YELLOW FEVER OF 1793.        169
  hundreds, who were not endowed with those rare and ex-
  traordinary qualities of mind!  Death, in this, as well as in
  many other cases in which medicine had done its duty, ap-
  peared to be the inevitable consequence of the total abstrac-
  tion of the energy of the mind in restoring the natural mo-
  tions of life.
    Under  all the circumstances which have been mentioned,
  which opposed the system of depletion in the cure of this
  fever, it was still  far more successful than any other mode
  of cure that had been pursued before in the United States,
  or in the  West-Indies.
    Three out of four died of the disease in Jamaica,  under
  the care of Dr. Hume.
    Dr. Blane considers it as one of the " most mortal" of
  diseases, and Dr. Jackson places a more successful mode
  of treating it among the subjects which  will  admit  of
  " innovation" in  medicine.
    After the 15th of September,  my success was much li-
  mited, compared with what it had been before that time.
  But at no period of the disease did I lose more than one in
  twenty of those whom I saw on the first day,  and attend-
  ed  regularly through every stage of the fever, provided
  they had  not been previously worn down by attending the
  sick.
    The following statement, which will admit of being cor-
 rected, if  it be inaccurate, will, I hope, establish die truth
 of the above assertions.
   About  one half of the families whom I have attended
 for  many  years, left the city.   Of those who remained,
 many were affected  by the disease.  Out of the whole of
 them, after I  had adopted my second mode of practice, I
 lost but five heads of families,  and about a dozen servants
 and children.   In  no instance did I lose both heads of the
 same family.  My success in these cases was owing to two
 eauses:  1st, To the credit my former patients gave to my
 public declaration, that we had only one fever in the city :
 hence they applied on theirs* day, and sometimes on the
first hour of their indisposition; and 2dly, To the numerous
 pledges many of them had seen of the safety and efficacy 6*f
 copious  blood-letting, by my advice,  in other diseases:
 hence my prescription of that necessary remedy was always
 obeyed in  its utmost extent.  Of the few adults whom 1
   vot..  in.               y 
170
AN ACCOUNT OF  THE
lost, among my former patients, two of them were old peo-
ple, two took laudanum,  without my knowledge, and one
refused to take medicine of any kind;  all the rest had been
worn down by previous fatigue.
   I have before said that a great number of the blacks were
my patients.   Of these not one died under my care.  This
uniform success, among  those people, was not owing alto-
gether to the mildness of the disease,  for  I  shall say  pre-
sently, that a  great proportion of a given number died, un-
der other modes of practice.
   In speaking of the comparative effects of purging and
bleeding, it may not be amiss to repeat, that not one preg-
nant woman,  to whom I prescribed them,  died or suffered
abortion.   Where the tonic  remedies were vised,  abortion
or death, and, in many  instances, both,  were nearly uni-
versal.
   Many whole families, consisting of five, six, and, in three
instances,  of  nine members,  were recovered  by  plentiful
purging and bleeding.   I could swell this work,  by pub-
lishing a list of those families; but I take more pleasure in
adding,  that I was not singvilar in  my success in the use of
the above remedies.  They were prescribed with great ad-
vantage by many  of the physicians of the city, who had for
a while given tonic medicines without effect.  I shall not
mention the names of any of the physicians who totally re-
nounced those medicines, lest I should give offence by not
mentioning them  all.  Many large families were cvired by
some of them,  after they adopted and prescribed copious
purging and blood-letting.   One  of them, cured ten  in the
family of Mr. Robert Haydock, by means of those reme-
dies.  In  one of that family, the disease came on with a vo-
miting of  black bile.
   But the use of the new remedies was not directed finally
by  the  physicians alone.   The clergy, the apothecaries,
many private citizens, several intelligent women,  and two
black men, prescribed them with great success. Nay more,
many persons prescribed them to themselves, and, as I shall
say hereafter, with a success that was unequalled by any of
the regular or irregular practitioners in the city.
   It was owing to the almost universal use of purging and
bleeding, that the mortality  of the disease diminished,  in
proportion as  the number of  persons who were affected by 
          BILIOUS  YELLOW FEVER OF  1793.      171

 it increased.   About the middle of October, it was scarce-
 ly double of what it was in the middle of September, and
 yet six times the number of persons were probably at diat
 time confined by it.
   The success  of copious purging  and bleeding was not
 confined to the city of Philadelphia.   Several persons, who
 were  infected in town,  and sickened in the country,  were
 cured by them.
   Could a comparison be made of the number of patients
 who died of  the yellow fever in 1793, after having  been
 plentifully  bled  and  purged, with  those  who died of the
 same disease in the years 1699,  1741, 1747, and 1762, I
 am persuaded that  the proportion would  be very small in
 the year 1793, compared with the former years.*   Includ-
 ing all who died  under every mode of treatment, I suspect
 the mortality  to be less, in proportion  to the population of
 the city, and the number of persons who were affected than
 it was in any of the other years that have been mentioned.
   Not less than  6000 of the  inhabitants of Philadelphia
 probably  ov/e their lives to  purging and bleeding,  during
 the autumn.
   I proceed with reluctance to inquire into the comparative
 success of the French practice.   It would not be difficult to
 decide upon it from many facts that came under my notice
 in the city; but  I shall rest its merit wholly  upon the re-
 turns of the number of deaths at Bush-hill.  This hospital,
 after the 22d of September, was pvit under the care of a
 French physician,  who was  assisted by one  of the physi-
 cians of  the city.  The hospital was in a  pleasant and airy
 situation; it was  provided with all the necessaries and com-
 forts for sick people that humanity could invent, or liberali-
 ty supply.  The attendants  were devoted to their duty;
and  cleanliness   and order  pervaded every  room  in the
 house.   The  reputation of this hospital, and of the French
 physician,  drew  patients to  it  in  the  early state  of the
 disease.   Of  this I have been assured  in a letter from Dr.
 Annan, who was appointed to examine and give orders of
admission into the hospital, to such of the poor of the dis-
  • It appears from one of Mr. Norris's letters, dated the 9th of November,
O. S. that there died  220 persons, in the year 1699, with the yellow fever.
 Between 80 and 90 of them, he says, belonged to the society of Friends. The
city, at this time, probably, did not contain more than 2 or 3000 people, many
of whom, it is probable, fled from the disease. 
172
AN ACCOUNT OF THE
trict of Southwark, as could be taken care of in their own
houses.    Mr.  Olden  has likewise  informed me, that
most of the patients who were sent to the hospital by the
city committee (of which he was a member) were  in the
first stage of the fever.  With  all these advantages, the
deaths between the 22d of September and the 6th of No-
vember,  amounted to 448 out of 807  patients who were
admitted into the hospital within that time.   Three fourths
of all the blacks  (nearly 20) who were patients in  this
hospital died.  A list of the medicines prescribed there
may be seen in the minutes of the proceedings of the city
committee.   Calomel  and jalap  are not among  them.
Moderate bleeding,  and purging  with  Glauber's  salts, I
have been informed, were used in some cases  by the phy-
sicians of this hospital.  The proportion of deaths to the
recoveries, as it appears in the minutes  of the committee
from whence the above report is taken,  is truly melancho-
ly !  I hasten from it therefore to a part of this work, to
which I have looked with pleasure, ever since I sat down
to compose it.
  I have said that the clergy, the apothecaries, and many
other persons  who were uninstructed in the principles of
medicine, prescribed  purging and  bleeding  with great
success in this disease.   Necessity gave rise to this undis-
ciplined  sect  of practitioners, for they  came  forward to
supply the places of the regular bred physicians who were
sick or dead.   I shall mention the names of a few of those
persons who distinguished themselves as volunteers in this
new work of humanity.  The late Rev. Mr. Fleming, one
of the ministers of the  Catholic church, carried the purging
powders in his pocket, and gave them to  his poor parishion-
ers with great success.  He even became the advocate of
the new remedies.  In a conversation I had with him, on
the 22d of September, he informed me, that he had advi-
sed four  of our  physicians,  whom he met  a day or  two
before, " to renounce the pride of science, and to adopt
the new mode of practice, for that  he  had witnessed its
good effects in many cases." Mr. John Keihmle, a German
apothecary, has assured me, that out  of 314 patients whom
he  visited, 'and 187  for whom  he  prescribed,  from the
reports of their friends, he lost but 47 (which is nearly but
one in eleven,) and that he treated them all agreeably to 
BILIOUS  YELLOW FEVER  OF  1793.
173
  the method which  I  had recommended.   The Rev. Mr.
  Schmidt, one  of the ministers of the Lutheran church, was
  cured by him.  I have before mentioned an instance oV the
  judgment of Mr. Connelly, and of his zeal in visiting and
  prescribing for the  sick.   His remedies were bleeding and
  purging.  He, moreover, bore  a constant and useful testi-
  mony against  bark, wine,  laudanum, and the warm bath *
  Mrs. Paxton  in Carter's  alley,  and Mrs. Evans, the wife
  ot  Mr. John Evans, in Second  street,  were indefatigable-
  the one  in  distributing  mercurial  purges  composed  by
  herself,  and the other in  urging the necessity  of copious
  bleeding and  purging among her friends and neighbours,
  as  the only safe remedies  for  the fever.   These worthy
  women were the means of saving many lives.t   Absalom
  Jones and Richard Allen,  two black men, spent all the in-
  tervals of time, in which they were not employed in bury-
  ing the dead,  in visiting the poor who were sick, and in
  bleeding and purging them, agreeably to  the directions which
  had been primed in all the newspapers.   Their success was
  unparalleled by what is called regular practice.  This enco-
  mium upon  the practice of the blacks will not surprise the
 reader when I add  that they had no fear of putrefaction in
  the fluids,  nor of the calumnies of a body of their fellow-ci
 zens in the republic of medicine, to deter them from plen-
 tiful purging and bleeding. They had, besides, no more pa-
 tients than they were able to visit two or three times a day
 But great as their success was, it was exceeded by those per
 sons, who, in despair of procuring medical aid of any kind
 purged and bled themselves.  This palm of superior success

  • In the letter before quoted, from Mr. Connelly, he expresses his ooininn «f
 those four med.cines in the following words  : « Laudanum bark  and St
 put a period to the existence of somf where the fe^fiSSt
 ken, and the patients n a fair way of recovery • a qin<rlP ,w "J• 1  a  y .
 hurried themU^^^^
 hot bath was used, and am convinced that it only tended to weaken^]  i
 the system, without producing any good effect"            ^  md *ehx
 ,JLThe- ycllow fever prevailed at the Caraccas, in South America  infVt«k
 1793, w.th great mortality  more especially  among the SptnSdroops Neart
 all d.ed who were attended by physicians. Recourse was finally had to The old ™f
men, who were successful in almost every case to which thev were called TW
 remedies  were a  hquor called narencado (a species of lemonade) and I tea
 S^h°fia ?? ca,lei>'Mjfl- With th«*e drinks they drenched their patients
 for the first two or three days. They induced plentiful sweats  *JI n£?K li
 after blunting, discharged the bile from the bowels  received tMs informfl?ly'
 froman American gentleman, who had been cured by  m'e oflhose wl ' ^
 medicine, m the above way.                             -^ma/ions in 
 174             AN ACCOUNT OF THE

 will not be withheld from those people,  when I explain the
 causes of it.  It was owing to their early use of the proper
 remedies, and to  their being guided in the repetition of
 them, by the continuance of a tense pulse,  or of pain and
 fever.  A day, an afternoon,  and even an hour, were not
 lost by these people in waiting for the visit  of a physician,
 who was often detained from them by sickness,  or  by new
 and unexpected engagements, by which means the precious
 moment for using the remedies with effect passed irrevoca-
 bly away.   I have stated these facts from faithful inquiries,
 and numerous observations.  I could mention the names
 and families of many persons who thus cured themselves.
 One person  only shall be mentioned,  who has shown by
 her conduct what reason is capable  of doing  when  it is
 forced to act for itself.   Mrs. Long, a widow, after having
 been twice unsuccessful in  her attempts to procure a phy*
 sician, undertook at last to cure herself.  She took several
 of the mercurial purges, agreeably to the printed directions,
 and had herself bled seven  times in the course of five or
 six days.   The indication  for repeating the bleeding was
 the continuance of the  pain in her head.  Her recovery was
 rapid and complete.  The history of it  was  communicated
 to me by herself,  with great gratitude, in my own house,
 during my second confinement with  the fever.  To  these
 accounts of  persons who cured themselves  in the  city,  I
 could add many others, of citizens  who sickened in the
 country, and who cured themselves by plentiful bleeding
 and purging, without the attendance of a physician.
  From a short review of these facts, reason and humanity
 awake from  their  long repose  in medicine, and unite in
 proclaiming,  that it is time  to take the  cure of pestilential
 epidemics out of the hands of physicians,  and to place it in
 the hands of the people.   Let not the reader startle at this
 proposition.   I shall give the following reasons for it.
  1.  In consequence of these diseases  affecting a number
 of people at one time,  it has always been, and always will
 be impossible,  for them all  to have the benefit of medical
aid, more especially as the proportion of physicians to the
 number of sick, is generally diminished upon these occa-
sions, by desertion, sickness, and death.
  2. The safety of committing to the people  the cure of
pestilential fevers,  particularly  the yellow fever and the 
BILIOUS YELLOW FEVER OF 1793.
175
plague, is established by the simplicity and  uniformity of
their causes, and of their  remedies.   However diversified
they may be in their symptoms,  the  system, in both  dis-
eases, is generally  under  a state of undue excitement or
great depression, and in most cases requires the abstraction
of stimulus in a greater or less  degree, or in a sudden or
gradual manner.  There can  never  be any danger of the
people injuring themselves by mistaking any other disease
for  an epidemic yellow fever or plague, for no other febrile
disease can prevail with them. It was probably to  prevent
this mistake, that the  Benevolent Father of mankind,  who
has permitted no evil to exist  which does not carry its
antidote along with it, originally imposed that law upon all
great and mortal epidemics.
  3. The history  of the yellow fever in  the West-Indies
proves the advantage of  trusting patients to  their  own
judgment.   Dr. Lind has remarked,  that a greater propor-
tion of Sailors who had no physicians recovered from  that
fever, than of those who had the best medical assistance.
The fresh air of the deck of a ship, a purge of salt water,
and the free use of cold  water, probably triumphed  here
over the cordial juleps of physicians.
   4. By committing the cure of this and other pestilential
epidemics to the people, all those  circumstances which
prevented the universal success of purging ?nd bleeding,
in this disease, will have no operation.   The fever will be
mild in most  cases, for  all-will prepare  themselves  to
receive it, by a vegetable diet, and by moderate evacuations.
The remedies will be used the moment the disease is felt,
or even seen, and its violence and danger  will thereby be
obviated.  There  will then be  no disputes among physi-
cians, about  the nature of the disease, to distract the public
mind, for they will seldom be consulted in it.  None will
suffer from chronic debility induced by previous fatigue in
attending the sick, nor  from the want of  nurses, for few
will be  so ill  as to  require  them, and  there  will be  no
" foreboding"  fears  of death, or despair  of recovery, to
invite an attack of the disease, or to ensure its mortality.
   The  small-pox was once as fatal as the yellow fever and
the plague.   It has since yielded as  universally to a vege-
table diet and evacuations, in  the hands of apothecaries*. 
176
AN  ACCOUNT.OF THE
 the clergy, and even of the good women, as it did in the
 hands of doctors of physic.
   They have narrow conceptions, not only of the Divine
 Goodness, but of the gradual progress of human know-
 ledge, who suppose that all pestilential diseases shall not,
 like the small-pox, sooner  or later cease to be the scourge
 and terror of mankind.
   For a long while, air, water,  and even the light of the
 sun,  were dealt out by physicians to their patients with a
 sparing hand.  They possessed,  for  several centuries, the
 same monopoly  of many artificial remedies.   But a new
 order of things is rising in medicine.  Air, water, and light
 are taken  without the advice of a physician, and bark and
 laudanum are  now prescribed every where by nurses and
 mistresses of families, with safety and advantage. Human
 reason cannot be stationary  upon these subjects.  The time
 must and will come, when,  in addition to the above reme-
 dies, the general use of calomel, jalap, and the lancet, shall
 be considered among the  most  essential  articles of the
 knowledge and rights of man.
   It is no more necessary that a patient should be ignorant
 of the medicine he takes, to be cured by it,  than that the
 business of government should be conducted with secrecy,
 in order to insure obedience to just laws.   Much less is it
 necessary that  the  means of life should be  prescribed in a
 dead language, or  dictated with the solemn pomp of a
 necromancer.  The effects  of  imposture,  in every thing,
 are like the artificial health produced by the  use of ardent
 spirits.   Its  vigour is temporary, and  is always followed
 by misery and death.
   The belief that the yellow fever and the  plague are ne-
 cessarily mortal, is as  much the  effect of a superstitious
 torpor in the understanding, as the ancient belief that the
 epilepsy was a supernatural disease, and that it was an of-
 fence against heaven to  attempt  to  cure  it.  It is partly
 from the influence  of this torpor in the minds of some
people, that the numerous cures  of the yellow fever, per-
formed by a few simple remedies, were said to be of other
diseases.    It is necessary, for the  conviction of such per-
 sons, that patients should always die of that,  and other dan-
 gerous disease, to prove  that they  have been affected by
 them. 
           BILIOUS YELLOW FEVER OF  1793.        177

   The repairs which our world is destined to undergo will
 be incomplete, until pestilential fevers cease to be number-
 ed among the widest outlets of human life.
   There are many things which are now familiar to women
 and children,  which were known a century ago only to a
 few men  who lived in closets, and were distinguished  by
 the name  of philosophers.
   We teach  a hundred things in our schools  less useful,
 and  many things more difficult, than the  knowledge  that
 would be necessary to cure a yellow fever or the plague.
   In my attempts to teach the citizens of Philadelphia,  by
 my different publications, the method of curing themselves
 of yellow fever, I observed  no difficulty  in their appre-
 hending every thing that was addressed to them, except
 what  related to the different states of the pulse.  All the
 knowledge that is necessary to discover when blood-letting
 is proper, might be taught to a boy  or girl of twelve years
 old in a few hours.   I taught it in less time to several per-
 sons, during the prevalence of the epidemic.
   I would as  soon believe that ratafia was intended by the
 Author of nature to be the  only drink of man, instead of
 water, as believe that the knowledge of what relates to the
 health and lives of  a whole city, or nation, should be con-
 fined to one, and that a small or a privileged order of men.
 But what have physicians, what have universities or medical
 societies done, after the labours and studies  of many  cen-
 turies, towards lessening the mortality of pestilential  fe-
 vers ?  They have either copied or contradicted each other,
 in all their publications.  Plagues and malignant fevers are
 still  leagued with war  and  famine,  in their  ravages upon
 human life.
   To prevent  the formation and mortality of this fever, it
 will be necessary, when it makes its appearance in a city or
 country, to  publish an account of those symptoms, which
 I have called the precursors of the disease, and  to exhort
 the people,  as soon as they feel those symptoms, to have
 immediate recourse to the remedies of purging or bleeding.
 The danger of delay in using one, or both these remedies,
should be inculcated in the strongest terms, for the disease,
like Time, has a lock  on its forehead,  but is bald behind.
 The bite of a rattle-snake is seldom fatal,  because the me-
dicines which  cure  it  are applied  or taken as soon as the
   vol. in.               z 
178
AN ACCOUNT OF THE
poison comes in contact with the blood.  There is  less
danger to be apprehended from the yellow fever than from
the poison of the snake,  provided the remedies for it are
administered within a  few hours after it is excited  into
action.
   Let persons who are subject to chronic pains, or diseases
of any kind,  be advised/iot to be deceived by them* Eve-
ry pain, at such a time,  is the beginning of the disease; for
it always acts first on debilitated  parts of the body.  From
an ignorance of this law of epidemics many persons, by de-
laying their applications for help,  perished with our fever.
   Let nature be trusted in no case  whatever,  to cure tiiis
disease; and let no attack of it,  however light, be treated
with neglect.   Death as  certainly performs his work, when
he steals on the system in the form  of a mild intermittent,
as he does, when he comes on with die symptoms of apo-
plexy, or a black vomiting.
   Cleanliness, in houses and dress, cannot be too  often in-
culcated during the prevalence of a yellow fever.
   Let it not be supposed, that I mean that the history which
I have given of the method of cure of this epidemic, should
be applied, in  all its parts, to the yellow fevers which may
appear hereafter in the United States, or which exist at all
times in the West-India Islands.   Season and climate vary
this, as well  as all other diseases.   Bark and wine, so fatal
in this, may be proper  in a future yellow fever.   But in
the climate of the United States, I  believe it will seldom
appear  with such  symptoms of prostration  and weakness,
as not to require,  in its first stage,  evacuations  of some
kind.
   The only inquiry, when the disease makes its appearance,
should be, from what part of the body these  evacuations
should be procured ;  the order which should be pursued in
obtaining them ; and  the quantity of each of the matters to
be discharged,  which should be withdrawn at a time.
   Thus far did I venture, from my theory of  the disease,
and from the authorities of Dr. Hillary and Dr. Mosely, to
decide in favour of evacuations  in  die  yellow fever;  but
Dr. Wade and Mr. Chisholm again support me,  by their
practice in the fevers of the East  and West-Indies.  They
both gave strong mercurial purges, and bled in some cases.
Dr. Wade confirmed, by his practice, the advantage of gra- 
           BILIOUS  YELLOW FIVER OF 1793.       179

 dually abstracting stimulus from  the system.   He never
 drew blood, even in the most inflammatory cases, until he
 had first discharged the contents of the bowels.   The doc-
 tor has further established the efficacy of a vegetable diet
 and of water as a drink, as the best means of preventing dis-
 ease in a hot climate.
   The  manner in which the miasmata that produce the
 plague act upon the  system is so much like that which has
 been described in the yellow  fever, and the accounts of the
 efficacy of low diet,  in preparing the body for its reception,
 and of copious bleeding, cold air and cold water, in curing
 it, are so similar, tiiat all the directions which relate to pre-
 venting, mitigating,  or curing the yellow fever may be ap-
 plied  to it.  The fluids  in die plague show a greater tend-
 ency  to the skin, than they do in the yellow fever. Perhaps,
 upon this account, the early use of powerful sudorifics may
 be  more proper in the former than in the latter disease.
 From the influence  of early  purging and bleeding in pro-
 moting sweats in the yellow fever, there can be little doubt
 but the efforts of nature to unload the system in the plague,
 through the channel  of the pores, might be accelerated  by
 the early use of the same remedies. One thing, with respect
 to the plague, is certain, that its cure depends upon the ab-
 straction of stimulus, either by means of plentiful sweats, or
 of purulent matter from external sores.  Perhaps the effica-
 cy of these remedies depends wholly upon their elevating
 the system from its prostrated state in a gradual manner.
 If this be the case, those natural discharges might be easily
 and effectually imitated by small and repeated bleedings.
  To correspond in quantity with the discharge from the
 skin,  blood-letting in the plague, when indicated, should
 be  copious.   A profuse sweat, continued for twenty-four
 hours, cannot fail of wasting many pounds of the fluids of
 the body.  This was the duration of the critical sweats in
 the famous plague which was known by the name  of the
 English sweating sickness, and  which made its appearance
 in the army of Henry VII.  in  Milford-Haven,  in Wales,
 and spread from thence through  every part of the kingdom.
  The principles which lead  to  the prevention and cure of
the yellow fever and the plague, apply with equal force to
 the mitigation of the measles, and to the prevention or mi-
 tigation of the  scarlatina anginosa, the dysentery, and the 
180
AN ACCOUNT OF THE
inflammatory jail fever.   I have remarked elsewhere,* that
a previous vegetable diet  lessened the violence and danger
of the measles.  Dr. Sims taught me, many years ago, to
prevent or mitigate the scarlatina anginosa,  by  means of
gentle purges, after children are infected by it.f  Purges of
salts have, in many instances, preserved whole families and
neighbourhoods from the dysentery, where they have been
exposed to its remote cause.  During the late  American
war, an emetic seldom failed of preventing an attack of the
hospital fever, when given in its forming state.J   I have
had no experience of the effects of previous evacuations in
abating the violence, or preventing the mortality of the ma-
lignant sore throat, but I can have no doubt of their effica-
cy, from the sameness of the state of the system in that dis-
ease, as in other malignant fevers. The debility induced in
it is from depression, and  the supposed symptoms of putre-
faction are nothing but the disguised  effects of a sudden
and violent pressure of an inflammatory stimulus upon the
arterial system.
   With these observations I close the history of the rise,
progress, symptoms, and treatment of the bilious remitting
yellow fever, which appeared in Philadelphia, in the year
1793.   My principal aim has been to revive and apply to
it, the principles and practice of Dr. Sydenham, and, how-
ever coldly those principles and that practice may be receiv-
ed by  some physicians of the present day, I am convinced
that experience, in all ages and in all countries, will vouch
for their truth and utility.
* Vol. ii.         f Medical Memoirs, vol. i.         t Vol. i. 
BILIOUS YELLOW  FEVER OF 1793.
181
                 A  NARKATIYE

                        OF THE

STATE OF THE BODY AND MIND OF THE AUTHOR, DURING THE
               PREVALENCE OF THE FEVER.


   NARRATIVES of escapes from great dangers of ship-
wreck,  war, captivity, and famine, have always formed an
interesting part of die  history of the body and mind of man.
But there are deliverances from equal dangers,  which have
hitherto passed unnoticed;  I mean from pestilential fevers.
I shall briefly describe the state of my body and mind dur-
ing my intercourse with the sick in the epidemic of 1793.
The account will throw  additional light upon  the disease,
and probably illustrate some of the laws of the  animal eco-
nomy :  It will, moreover, serve to furnish a lesson to all who
may  be placed in similar circumstances, to commit  their
lives, without fear, to the protection of that Being, who is
able to save to the uttermost, not only from future, but from
present evil.
   Some time before the fever made its appearance, my wife
and children went into the state of New-Jersey, where they
had long been in the habit of spending the summer months.
My family,  about  the 25th of August, consisted of my
mother, sister, who was  on a visit  to me,  a black servant
man,  and a mulatto boy.   I had five pupils, viz.  Warner
Washington and Edward Fisher, of Virginia; John Alston,
of South-Carolina,  and  John Redman Coxe (grandson to
Dr. Redman)  and John Stall, both of this city.  They all
crowded around me upon the sudden increase of business,
and with one heart  devoted themselves to my service, and
to the cause of humanity.
   The credit  which the new mode of treating the disease
acquired, in all parts of the city, produced an immense in-
flux of patients to me from all quarters.   My pupils  were
constantly employed; at first in putting up purging  pow- 
182
AN  ACCOUNT OF THE
ders,  but,  after a while,  only in bleeding and visiting die
sick.
  Between the 8th and  the 15th of September, I visited
and prescribed for between a hundred and a hundred and
twenty patients a day.  Several of my pupils visited a fourth
or fifth part of that number.  For a while we refused no
calls.  , In the short intervals of  business, which I spent at
my meals, my house was filled with patients,  chiefly the
poor, waiting for advice.   For many weeks  I seldom ate
without prescribing for numbers as I sat at m$ table.  To
assist me at these hours, as well as in the night, Mr. Stall,
Mr. Fisher, and Mr. Coxe accepted of rooms in my house,
and became members of my family.  Their  labours now
had no remission.
  Immediately after I adopted  the antiphlogistic mode of
treating the disease, I altered my manner of living.   I left
off drinking wine and malt liquors.  The good effects of
the disuse of these liquors helped to confirm me in the the-
ory I had adopted of the disease. A troublesome head-ach,
which I had occasionally  felt, and which excited a constant
apprehension that I was taking the fever, now suddenly left
me.   I likewise, at this time,  left off eating solid  animal
food, and lived wholly, but sparingly,  upon weak broth,
potatoes, raisins, coffee, and bread and butter.
  From my constant exposure to the sources of the disease,
my body became highly impregnated with miasmata.  My
eyes were yellow,  and sometimes a yellowness was percep-
tible in  my face.   My pulse was preternaturally  quick, and
I had profuse  sweats every night.   These sweats were so
offensive, as to oblige me to draw the bed-clothes close to
my neck,  to defend myself from their  smell.  They lost
their foetor  entirely, upon my leaving off the use of broth,
and living  entirely upon  milk and vegetables.  But my
nights were rendered disagreeable, not only by these sweats,
but by the want of my usual sleep, produced in part  by the
frequent knocking at my  door, and in part by  anxiety of
mind, and the stimulus of the miasmata upon my system.
I went to bed  in conformity to habit only, for it ceased to
afford me rest or  refreshment.  When it was  evening I
wished  for morning; and when it was morning, the pros-
pect of  the labours of the day, at which I often shudder-
ed, caused  me to wish for the return of evening. The de- 
BILIOUS YELLOW  FEVER OF  1793.
183
grees of my anxiety may be easily conceived when I add,
that I had at one time  upwards of thirty heads of families
under my care;  among these were Mr. Josiah Coates, die
father of eight, and Mr. Benjamin Scull and Mr. John Mo-
rell, both fathers of ten children.  They were all in immi-
nent danger; but it  pleased God to make me the instru-
ment  of saving each of their lives.  I rose at six o'clock,
and generally found a number of persons waiting for advice
in my shop or parlour.  Hitherto the success of my prac-
tice gave a tone to my mind, which imparted preternatural
vigour to my body.  It was meat and drink  to me to fulfil
the (duties I  owed to my fellow-citizens, in this time  of
great  and universal  distress.  From a hope that I might
escape the disease, by avoiding every thing that could ex-
cite it  into action, I carefully avoided the heat of the sun,
and the coldness of the evening air.   I likewise avoided
yielding to every thing that should raise or depress my pas-
sions.  But at such  a time,  the events which influence the
state of the body and mind are no more under  our com-
mand  than  the  winds or weather.  On the evening of the
14th of September,  after eight o'clock, I visited  the son of
Mrs. Berriman, near the Swedes' church, who had sent for
me early in the morning.   I found him very ill.   He had
been bled in the forenoon, by my advice,  but his pulse in-
dicated a second bleeding.   It would have been difficult to
procure a bleeder at that late hour.  I therefore bled him
myself.  Heated by this act, and debilitated by the labours
of the day,  I rode  home in the evening air.  During the
ensuing night  I was much indisposed.   I rose, notwith-
standing, at my usual hour.   At eight o'clock  I lost ten
ounces of blood, and immediately afterwards got into my
chair,  and visited between  forty and fifty patients before
dinner.  At the house of one of them I was forced to  lie,
down  a few minutes.   In the course of this morning's  la-
bours my mind was suddenly thrown off its pivots,  by the
last look,  and the pathetic cries, of a friend for help, who
was dying under the care of a French physician.  I came
home about two o'clock, and was seized, immediately after-
wards, with a chilly fit and a high fever.  I took a dose of
the mercurial medicine, and Avent to bed.  In the evening
I took a second purging powder, and lost ten ounces more
of blood.   The next morning  I  bathed my face, hands. 
184
AN  ACCOUNT OF  THE
 and feet, in cold water for some time.  I drank plentifully,
 during the day and night, of weak hyson tea, and of water,
 in which currant jelly had been dissolved.  At eight o'clock
 I was so well as to admit persons who cane for advice
 into  my room, and to  receive reports from  my pupils
 of the state of as many  of  my patients as they were able
 to visit;  for, unfortunately, they were  not able  to  visit
 them all (with their own) in due time -f in consequence of
 which several died.   The next day I  came down stairs,
 and  prescribed in my parlour for not less than a hundred
 people.  On  the 19th  of  the  same  month,   I resumed
 my labours, but in great weakness.   It was with difficulty
 that I ascended a pair of stairs, by the help of a banister.
 A slow fever, attended with irregular chills, and a trouble-
 some  cough,  hung constantly upon  me.  The fever  dis-
 covered itself in the heat of my hands,  which my  patients
 often told  me were warmer than their own.  The breath
 and  exhalations from the sick now began to affect me,  in
 small and  infected rooms,  in the most sensible manner.
 On  the morning of the  4th of October I suddenly sunk
 down, in a sick room, upon a bed, with a giddiness in my
 head.   It continued  for a few minutes, and was succeeded
 by a fever, which confined me to my house the remaining
 part of the  day.
  Every moment in the  intervals of my visits to the sick
 was  employed in prescribing,  in  my own house,  for the
 poor,  or in sending answers to messages from  my  pa-
 tients ;  time was now too precious to be  spent in count-
 ing the number of persons who called upon me for advice.
 From circumstances I believe it was frequently 150,  and
 seldom less than 50 in a day, for  five or six weeks.  The
 evening did not bring with it the least relaxation from my
 labours.  I received  letters  every day from the country,
 and  from distant parts of the Union,  containing inquiries
 into  the mode of treating the disease, and after the health
 and lives of persons who had remained  in the  city.  The
 business of every evening was to answer these letters, also
 to write to my family.  These employments, by affording
 a fresh current to my thoughts, kept me from dwelling on
the  gloomy scenes of the day.  After these duties were
performed,  I copied into my note book all the observations
I had collected  during the day, and which I had marked 
          BILIOUS YELLOW FEVER OF 1793.       185

with a pencil in my pocket-book  in sick rooms, or in my
carriage.  To these constant labours of body and  mind
were added distresses from a variety of causes.   Having
found myself unable to comply with the numerous appli-
cations that  were made to me, I was  obliged to refuse
many every  day.  My  sister  counted forty-seven in one
forenoon before eleven  o'clock.  Many of them  left my
door with tears,  but they did not feel more distress than I
did from  refusing to  follow  them.  Sympathy,  when it
vents itself in acts of humanity, affords pleasure, and con-
tributes to health; but the reflux of pity, like anger, gives
pain, and disorders the body. In riding through the streets,
I was often forced to resist the  intreaties of parents implo-
ring a visit to their children, or of children to their parents.
I recollect, and even yet with  pain, that I tore myself at
one time from five persons in Moravian alley, who attempted
to stop me,  by suddenly whipping my horse, and driving
my chair as  speedily as  possible beyond the reach  of their
cries.
   The solicitude of the friends of the sick for help  may
further be conceived of, when I add, that the most extra-
vagant compensations were sometimes offered for  medical
services,  and, in one  instance, for only a  single visit.   I
had no merit in refusing these offers, and 1  have  introdu-
ced an account of them only to inform such physicians as
may hereafter be thrown into a similar situation, that I was
favoured  with an exemption  from the  fear  of death,  in
proportion as I subdued every  selfish feeling, and labour-
ed exclusively for the benefit of others.   In every instance
in which I was forced to refuse these pathetic and earnest
applications, my distress was  heightened by the  fear that
the persons, whom I was unable to  visit, would  fall into
improper hands, and perish by  the use of bark, wine, and
laudanum.,
   But I  had  other afflictions  besides the distress which
aroae from the abortive sympathy which  I have described.
On the 11th  of September,  my ingenious  pupil,  Mr.
Washington, fell a victim to-his humanity.  He had taken
lodgings in the country, where  he sickened  with  the dis-
ease.  Having been almost uniformly successful in curing
others, he made light of his fever, and concealed the know-
ledge of his danger from me, until the day before he died.
   vol. in.               ^ a 
186               AN ACCOUNT  OF THE
On the 18th of September Mr. Stall sickened in my house.
A delirium attended his fever  from the first hour it affect-
ed him.  He refused, and even resisted  force when used
to compel him to take medicine.   He died on the 23d of
September.* Scarce  had  I  recovered from  the shock of
the death of this amiable youth, when L was called to  weep
for a third pupil, Mr. Alston,  who died in my neighbour-
hood the next day.   He had  worn  himself  down, before
his sickness, by  uncommon exertions in visiting, bleeding,
and even sitting up  with  sick people.   At  this time Mr.
Fisher was ill in my house.  On the 26th  of the month,
at  12  o'clock,  Mr.  Coxe, my only assistant was seized
with the fever,  and  went  to his grand-father's.  I followed
him with a look, which I feared would be the last in my
house.   At two o'clock my  sister,  who had complained
for several  days, yielded to the disease, and retired to her
bed. My mother followed her, much indisposed, early  in
the evening.  My black servant  man had been confined
with the fever for several days,  and  had on that day, for
the first time quitted his bed.  My little mulatto boy,  of
eleven years old, was the only  person in my family  who
was able to afford me the least assistance. At eight o'clock
in the evening I finished the business of the day.  A so-
lemn stillness at that  time pervaded  the streets.  In vain
did I strive to forget  my melancholy situation by answering
letters and by putting up medicines, to be distributed next
day among my patients.   My faithful black man crept to
my door, and at my request sat down by the fire, but he

  * This accomplished youth had  made great attainments in his profession.
He possessed, with an uncommon genius for science, talents for music,  paint-
ing, and poetry. The following copy of an unfinished letter to his father (who
had left the city) was found among his papers after his death.  It shows that
the qualities of his heart were equal to those of his head.

                               " Philadelphia, September 15, 1793.
" MY DEAR FATHER,
    " I take every moment 1 have to spare to write to you, which is not many;
but you must excuse me, as I am doing good  to my fellow-creatures.  At this
time, every moment I spend in idleness might probably cost a life. The sick-
ness increases every day, but most of those who die, die for want of good at-
tendance.   We cure all we are called to on the first day, who are well attend-
ed, but so many doctors are sick, the poor creatures are glad to get a doctor's
servant." 
          BILIOUS YELLOW  FEVER OF 1793.       187

 added, by his  silence and dulness, to  the gloom, which
 suddenly overpowered every faculty of my mind.
   On the first  day of October, at two o'clock in the after-
 noon, my sister died.   I got into  my carriage within an
 hour after she  expired, and spent  the afternoon in visiting
 patients.  According as a  sense of duty, or as grief has
 predominated in my mind,  I have approved, and disap-
 proved,  of this act, ever since.   She had borne a  share in
 my labours.  She had been my  nurse in sickness, and my
 casuist in my choice of duties.  My  whole heart reposed
 itself in her friendship.   Upon  being invited to a friend's
 house in the country, when  the disease  made its appear-
 ance  in the city, she declined accepting the  invitation,  and
 gave as a reason for so doing,  that I might probably re-
 quire her services in case of my taking the disease, and that,
 if she were  sure of dying, she would  remain with  me,
 provided that, by her death, she could save my life.  From
 this time I declined  in  health and strength.  All motion
 became painful  to me.   My  appetite began to fail.   My
 night sweats continued.  My short and imperfect  sleep
 was  disturbed by distressing or frightful  dreams.   The
 scenes of them were derived  altogether  from  sick rooms
 and grave  yards.  I  concealed my sorrows  as  much as
 possible from my patients ;  but when alone, the retrospect
 of what was past, and the prospect of what was before  me,
 the termination of which  was invisible, often filled my soul
 with the most poignant anguish.  I wept  frequently  when
 retired from the public eye, but I did not weep  over  the
 lost members of my family alone. I beheld or heard every
day of the deaths of citizens,  useful in  public, or amiable
 in private  hfe.   It was my misfortune to lose as patients
 the Rev. Mr. Fleming and  Mr.  Graesel,  both exhausted
by their labours of piety  and love among the poor, before
they sickened with the disease.  I saw the last struggles of
departing life in Mr. Powell, and deplored, in his death, an
upright and faithful servant of the public, as well as a  sin-
cere and affectionate friend.  Often  did I  mourn over per-
sons who had, by the  most unparalleled  exertions,  saved
their friends and families from  the grave, at the expense of
their own lives.   Many of these martyrs to humanity were
in humble stations.  Among the members of my profes-
sion, with whom I have been most intimately connected, T 
188              AN ACCOUNT OF THE

had daily cause of grief and distress.   I saw the great and
expanded mind of Dr. Pennington, shattered by delirium,
just before he died.   He was to me dear and beloved, like
a younger brother.   He was, moreover, a Joab in the con-
test with  the disease.   Philadelphia must long deplore the
premature death of this excellent physician.  Had he lived a
few years longer, he would have filled an immense space in
the republic of medicine.*  It was my affliction to see my
friend Dr. John  Morris  breathe his  last,  and to hear the
first effusions of the most pathetic grief from his mother,
as she bursted from the room in which  he  died.   But
I had distress  from the sickness, as  well  as the deaths of
my brethren  in physic.   My worthy friends, Dr. Grifntts,
Dr. Say, and Dr. Mease, were suspended by a thread  over
the grave, nearly at  the same  time.   Heaven,  in mercy to
me, as well as in kindness to  the public and their friends,
preserved their lives.   Had they died, the measure of my
sorrows would have been complete.
   I have said before,  that I early left off drinking wine;
but I  used  it  in another way.  I carried a little of it in a
vial  in my pocket, and  when I felt myself fainty, after
coming out of a sick room,  or after a long ride, I  kept
about a table spoonful of it in my mouth for half a minute,
or longer, without swallowing it.  So weak and excitable
was my system, that this small quantity of wine refreshed
and invigorated me as much as half a  pint would have done
at any other time. The only difference was, that the vigour
I  derived from  the wine in  the former,  was x>f shorter
duration than when taken in the latter way.
   For the first two weeks after I visited  patients  in the
yellow fever,  I carried a rag wetted with vinegar,   and
smelled it occasionally in sick rooms: but after I saw and
felt the signs of the universal presence of miasmata in my
system, I laid  aside this and all  other precautions. I rested
myself on the  bed-side of my patients, and I  drank milk
or eat fruit  in  tiieir sick rooms.  Besides being saturated
with  miasmata, I had  another security against being in-
fected in sick rooms, and  that  was,  I went into scarcely a
  * Before he finished his studies in medicine, he published a volume of inge-
nious and patriotic  " Chemical and Economical Essays, designed to illustrate
the connection between the theory and practice of chemistry, and the applica,-
tionof  that science to some of the arts and manufactures of the United States
of America." 
          BILIOUS YELLOW  FEVER OF 1793.       189

house which was more  infected than my own.  Many of
the poor people, who called upon me for advice, were bled
by my pupils in my shop, and in the yard which was between
it and the street.   From the want of a sufficient number of
bowls to receive their blood,  it was sometimes suffered to
flow  and putrefy  upon  the   ground.   From this source,
streams of miasmata were constantly poured into my house,
and conveyed into my body by the air, during every hour
of the day and night.
   The deaths of my pupils and sister have often been urged
as objections to my mode of  treating the fever.   Had the
same degrees of  labour and  fatigue, which  preceded  the
attack  of the yellow fever in each  of  them, preceded an
attaek of a common pleurisy,  I think it probable that some,
or perhaps all of them, would  have died with  it.  But when
the influence of the concentrated miasmata which filled my
house  was added to that of  constant  fatigue upon their
bodies, what remedies  could  be  expected  to  save their
lives?  Under the above  circumstances, I consider the re-
covery of the other branches of my family from the fever
(and none of them  escaped  it)  with emotions, such  as I
should feel had we all been revived from apparent death by
the exertions of a humane society.
   For upwards of six weeks  I did not  taste  animal food,
nor fermented liquors of any kind.  The quantity of aliment
which I took, inclusive of drinks, during this  time,  was
frequently  not more  than one or two pounds in a day.
Yet  upon  this diet I possessed, for a while, uncommon
activity of body.  This influence of abstinence upon  bodily
exertion  has been happily illustrated by Dr. Jackson, in
his directions for  preserving the health of soldiers  in hot
climates.   He tells us, that he walked a hundred miles in
three days, in Jamaica, during which time he breakfasted
on tea, supped on bread and sallad, and drank nothing  but
lemonade or water.  He adds further, that he walked from
Edinburgh to London in  eleven days and a  half, and  that
he travelled with  the  most ease when he ortly breakfasted
and  supped, and  drank nothing but water.   The fatigue
of riding on horseback is prevented or lessened by absti-
nence from solid  food.  Even the  horse suffers least from
a  quick and long journey when he  is fed sparingly with
hay.  These facts add weight to the arguments formerly 
190
AN ACCOUNT OF THE
 adduced, in favour of vegetable diet, in preventing or mi-
 tigating the action  of the  miasmata  of  malignant fevers
 upon the system. In both cases the abstraction of stimulus
 removes the body further from the reach of undue excite-
 ment and morbid depression.
   Food supports life  as much  by  its stimulus,  as  by
 affording nourishment  to the body.   Where  an artificial
 stimulus acts upon  the system,  the  natural  stimulus  of
 food ceases to  be necessary.  Under the influence of this
 principle, I increased or diminished my food with the signs
 I discovered of the  increase or diminution of  the seeds of
 the  disease in  my body.   Until the  15th of September I
 drank weak coffee,  but after that time I drank nothing but
 milk, or milk and water, in the intervals of  my  meals.  I
 was so satisfied of the  efficacy of this mode of living, that
 I believed life might have been  preserved, and a  fever
 prevented,  for many days, with a much greater accumula-
 tion of miasmata in my system, by means of a total absti-
 nence from food.  Poison is a relative term, and  an excess
 in quantity, or a derangement in  place, is necessary to its
 producing deleterious  effects. The miasmata of the yellow
 fever produced  sickness and death  only from the excess of
 their quantity,  or from their force being increased by the
 addition of those other stimuli  which I  have  elsewhere
 called exciting causes.
   In addition to low diet, as a preventive of the  disease, I
 obviated costiveness by taking occasionally a calomel pill,
 or by chewing rhubarb.
   I  had read and  taught,  in  my lectures, that fasting
 increases acuteness in the sense of touch.  My low  living had
 that  effect, in a  certain degree, upon my fingers.   I had a
 quickness in my p.rception, of the  state of the  pulse in the
 yellow fever, that I had  never experienced  before in  any
 other disease.   My  abstemious diet,  assisted  perhaps by
 the state of my feelings, had likewise an influence  upon my
 mind.  Its  operations  were performed with an ease and a
 celerity,  which  rendered my num rous and  complicated
duties much less burdensome than they would  probably
have been  under other circumstances of diet, or a less
agitated state of my  passions.
   My perception of  the lapse of time was new to  me. It
 was  uncommonly slow.  The ordinary business and pur- 
BILIOUS YELLOW FEVER OF 1793.
191
suits of men appeared to me in a light that was equally new.
The hearse and the grave mingled themselves with every
view I took of human  affairs.  Under these impressions I
recollect being as much struck with observing a number
of men, employed in digging the cellar of a large house, as
I should have been,  at  any other time, in seeing prepara-
tions for building a palace upon a cake of ice.  I recollect,
further, being struck with surprise, about the 1st of Octo-
ber, in seeing a man busily employed in laying in  wood
for the approaching winter.   I should as soon have thought
of making provision for a dinner on the first day of the
year 1800.
   In the account of my distresses,  I  have passed over the
slanders which were  propagated against me by some of my
brethren.   I have mentioned them only for the sake of
declaring, in this public manner, that I  most heartily for-
give them ; and that if I discovered, at any time, an undue
sense  of the unkindness and cruelty  of  those slanders, it
was not because  I felt myself injured by them, but because
I was sure they would  irreparably injure my fellow-citizens,
by lessening their confidence in the only remedies  that I
believed  to be  effectual  in  the reigning epidemic.   One
thing  in my conduct towards these gentlemen may require
justification ; and that is, my refusing to  consult with them.
 A Mahometan and a Jew might as well attempt to worship
 the Supreme Being in the  same  temple, and through the
 medium  of the same  ceremonies, as two physicians of op-
 posite principles  and practice attempt to confer about the
 life of the same  patient.   What is done in consequence of
 such  negotiations (for they are  not consultations)  is  the
 ineffectual  result of neutralized  opinions; and  wherever
 they  take place,  should be considered as the effect of a
 criminal  compact between physicians, to assess the property
 of their patients, by a shameful prostitution of the dictates
 of their consciences.  Besides,  I early  discovered  that it
 was  impossible  for me,  by any reasonings,  to change the
 practice of some of my brethren.   Humanity was, therefore,
 on the side of leaving  them to  themselves ; for the extre-
 mitv  of wrong in medicine,  as in morals and government,
 is often a less mischief than that mixture of right and wrong
 which serves, by palliating,  to perpetuate evil.
    After the loss of  my health I received letters from  mv 
192
AN ACCOUNT OF THE
\
 friends in the country, pressing me, in the strongest terms,
 to leave the city.  Such a step had become impracticable.
 My aged mother was too infirm to be  removed, and  I
 could not leave her.  I was, moreover, part of a little circle
 of physicians, who had associated themselves in support of
 the new remedies. This circle would have been broken by
 my quitting the  city.  The  weather varied  the disease,  and,
 in the weakest state of my body, I  expected to be able,
 from the reports of my pupils, to assist my associates in
 detecting its  changes, and in accommodating our remedies
 to them.   Under these circumstances it  pleased God to
 enable me to reply to  one of the letters  that  urged my
 retreat from  the  city, that  " I  had resolved to stick to
 my principles, my practice,  and my patients,  to the last
 extremity."
   On  the 9th of October,  I visited a considerable number
 of patients, and, as  the day  was  warm, I lessened the
 quantity of my clothing.  Towards evening  I was  seized
 with a pain in the back, which obliged me to go to bed at
 eight o'clock.  About twelve I awoke with a chilly fit. A
 violent fever, with acute pains in different parts of my body,
 followed it.  At one  o'clock I called for Mr. Fisher,  who
 slept in the next  room.  He came  instantly, with my
 affectionate black man, to  my relief.   I  saw my danger
 painted in Mr. Fisher's countenance.   He bled me  plenti-
 fully,  and gave  me  a  dose of the  mercurial medicine.
 This was immediately rejected.  He  gave me a second
 dose, which  likewise acted as an emetic, and discharged  a
 large quantity of bile from my stomach.   The remaining
 part of the night was passed under an  apprehension that my
 labours were near an end. I could hardly expect to survive
 so violent an attack of the fever, broken down, as I was, by
 labour, sickness, and grief.  My wife and seven children,
 whom the great  and distressing events that were passing in
 our city had jostled out of my mind for six or seven weeks,
 now resumed their former place in my affections. My  wife
 had stipulated, in consenting to remain  in the couutry, to
 come to my assistance in case of my sickness ;  but  I took
 measures which,  without alarming her, proved effectual in
preventing it.  My house was enveloped in foul air,  and
 the probability of my  death made her life doubly necessary
 to my family. In the morning the medicine operated kindly. 
           BILIOUS  YELLOW FEVER OF 1793.       193

and my fever abated. In the afternoon it returned, attend-
ed with a great inclination to sleep.   Mr. Fisher bled me
again,  which removed the sleepiness.   The  next day the
fever left me, but in  so weak a state, that I awoke two suc-
cessive nights with a faintness which threatened the extinc-
tion of my life.  It was removed each time by taking a lit-:
tie aliment.   My convalescence was extremely slow.   I re-
turned, in a very gradual manner,  to my former habits  of
diet.   The smell of animal food, the  first time I saw it at
my table,  forced me  to leave the room.  During the month
of November, and all the winter  months, I was harassed
with a cough, and a fever somewhat of the hectic  kind.
The early warmth of the spring removed those complaints,
and restored me,  through Divine Goodness,  to  my  usual
state of health.
  I should be deficient in gratitude, were 1 to conclude this
narrative without acknowledging my obligations to my sur-
viving pupils, Mr. Fisher and Mr.  Coxe, for the grei.t sup-
port and sympathy I derived from  them in my labours and
distresses.
  I take great pleasure likewise in  acknowledging my obli-
gations to my former pupil, Dr. Woodhouse, who assisted
me in the care of my patients, after I became so weak as not
to be able to attend them with the punctuality their  cases
required.   The disinterested  exploits of these "young  gen-
tlemen in the cause  of humanity,  and. their success in the
treatment of the disease, have endeared their names to hun-
dreds,  and, at the same time, afforded a prelude of their fu-
ture eminence and usefulness in their profession.
  But  wherewith shall I come before the great FATHER
and REDEEMER of men, and what shall  I render unto
Him for the issue of my life from the grave ?

              Here all language fails:
          f?ome then, expressive silence, muse his praine
VOL. IIJ-              * b 
 
           AN ACCOUNT





              OF THE





BILIOUS REMITTING AND INTERMITTING





         YELLOW FEYER,





               AS IT





     APPEARED IN PHILADELPHIA,





          r.V THE YEAR 1794. 
 
AN  ACCOUNT, &c.
   I CONCLUDED the history of the symptoms of the
bilious remittent yellow fever, as it appeared in Philadel-
phia,  in the year 1793, by taking notice, that the diseases
which succeeded that fatal epidemic  were all of a highly
inflammatory nature.                  '
   In  that history I described the weather and diseases of
the months of March and April, in the spring of 1794.
   The weather,  during the first three weeks of the month
of May, was dry and temperate, with now and then a cold
day and night.  The strawberries were ripe on the  15th,
and cherries on the 22d, day of the month, in several of the
city gardens.  A shower of hail fell on the afternoon of the
22d,  which broke  the glass windows of many houses.  A
single stone of this hail  was found to  weigh two drachms.
Several people collected  a quantity of it, and preserved  it
till the next day in their cellars, when they used it for the
purpose of cooling their wine. The weather, after this hail
storm, was rainy during  the remaining part of the month.
The diseases were  still inflammatory.  Many persons were
afflicted with a sore mouth in this month.
   The weather in J tine was pleasant and temperate.  Seve-
ral intermittents, and two very acute pleurisies, occurred in
my practice during this month.  The  intermittents  were
uncommonly obstinate, and would not yield to the largest
doses of the bark.
   In a son of  Mr.  Samuel Coates, of seven years old, the
bark produced a sudden translation of this state of fever to
the head,  where it produced all the symptoms of the first
stage  of internal dropsy of the brain. This once formidable
disease yielded, in this case,  to three bleedings,  and  other
depleting  medicines.  The blood drawn in every instance
was sizy. 
198
AN ACCOUNT  OF THE
    From the inflammatory complexion of the diseases of the
 spring, and of the beginning of June,  I expected the fevers
 of the summer and autumn would be of a violent and ma-
 lignant nature.   I was the more disposed to entertain this
 opinion from observing the stagnating filth of the gutters of
 our city ; for the citizens of Philadelphia, having an interest
 in rejecting the proofs of the generation of the epidemic of
 1793  in tneir city, had neglected to  introduce the regula-
 tions which were necessary to prevent the production of a
 similar fever from domestic putrefaction.   The)'- hud, it is
 true, taken pains to remove the  earth  and offal matters
 which accumulated in the streets; but these, from their be-
 ing  always dry, were inoffensive as remote causes  of dis-
 ease.  Perhaps the removal of the earth did harm, by pre-
» venting the absorption of the miasmata which were con-
 stantly exhaled from the gutters.
    On the 6th of June, Dr. Physick called upon me,  and in-
 formed me that he had a woman in the yellow fever under
 his  care.   The information  did not surprise me, but it
 awakened suddenly  in my mind the most distressing emo-
 tions. I advised him to inform the mayor of the city of the
 ease, but by no means to make it more public, for I hoped
 that it might be a sporadic  instance of the disease, and that
 it might not become  general in the city.
    On the  12th of the month, my fears of the  return of the
 yellow fever were revived by visiting  Mr. Isaac Moms,
 whom I found very ill with a violent  puking,  great pain in
 his head, a red eye, and a slow tense pulse.  I ordered him
 to be bled, and purged him plentifully with jalap and calo-
 mel.  His blood had that appearance which has been com-
 pared by authors to  the washings  of raw  flesh  in water.
 Upon his recovery, he told me that he " suspected he had
 had the yellow fever,  for that his feelings were exactly such
 as they had been in the fall of 1793,  at which time he had
 an attack of that disease."
    On the  14th of June,  I  was sent for, in  the absence of
 Dr. Mease, to visit his sister in a fever.  Her  mother, who
 had become intimately  acquainted  with the yellow fever,
 by nursing her son and mother in it, the year before,  at once
 decided upon the name of her daughter's disease.  Her
 symptoms  were violent,  but they appeared  in an intermit-
 ting form.   Each paroxysm of her fever was  like a hurri- 
         BILIOUS YELLOW  FEVER OF 1794.      199

cane to her whole system.  It  excited apprehensions of im-
mediate dissolution in the minds of all  her friends.   The
loss  of sixty ounces of blood, by five bleedings,  copious
doses of calomel and jalap, and a large blister to her neck,
soon vanquished  this malignant intermittent, without the
aid of a single dose of bark.
   During the remaining part of the month,  I was called to
several cases of fever,  which had symptoms of malignity of
a suspicious nature.  The son of Mr. Andrew Brown had
an haemorrhage from his nose in a fever, and a case of me-
norrhagia occurred in a woman, who was affected with but
a slight degree of fever.
   In the course of this month, I met with several cases of
swelled testicles, which had succeeded fevers, so slight as to
have required no medical aid.  Dr. Desportes records si-
milar instances of a swelling in the testicles,  which appear-
ed during the prevalence of the yellow fever in St. Domin-
go, in the year 1741.*
   In the month of July, I visited James  Lefferty and Wil-
liam Adams, both of whom had, with the usual symptoms
of yellow fever, a yellow colour on their skin.  I likewise
attended three women,  in whom I  discovered the disease
under forms in which I had often seen it in the year 1793.
In two of them it appeared with symptoms of a violent co-
lic, which yielded only to frequent bleedings. In the third,
it appeared  with symptoms of pleurisy, which was attended
with a constant haemorrhage from the uterus, although blood
was drawn almost daily from her arm, for six or seven days.
About the middle of this month many people complained
of nausea, which in some cases produced a puking, without
any  symptoms of fever.
   During  the month of August,  I was  called to Peter
Denham,  Mrs. Bruce, a son  of Jacob Gribble, Mr. Cole,
John Madge,  Mrs. Gardiner, Miss Purdon, Mrs. Gavin,
and  Benjamin Cochran, each of whom had all the usual
symptoms of the yellow fever.   I found Mr. Cochran sit-
ting on the side  of his bed, with  a pot in his hand, into
which he was discharging black matter  from his stomach,
on the 6th  day of the disease.   He died on the next day.
Mrs. Gavin died on the 6th day  of her disease, from a want
of sufficient bleeding, to which she objected, from the in-
          * Histoire des Maladies de Saint Domingue, p. 112. 
200
AN  ACCOUNT OF THE
fluence of her friends.  Besides the above persons, I visit-
ed Mr. George Eyre,  at Kensington, Mr.  Thomas Fitz-
simmons, and Thomas M'Kean, jun. son of the chief jus-
tice of Pennsylvania, all of whom had the disease, but in a
moderate degree. During this time I took no steps to alarm
my fellow-citizens with the unwelcome news of its being in
town.  But my mind  was not easy in this situation, for I
daily heard of persons who died of the disease, who might
probably have been saved  had they applied early  for relief,
or had a suspicion become general among  all our physi-
cians of the existence of the yellow fever in the city. The
cholera infantum was common during this, and part of the
preceding month.  It was more obstinate and more fatal
than in common years.
  On  the 12th of this month, a letter from Baltimore  an-
nounced the existence of the yellow fever in that city.
One of the patients whom  I visited in this month, in the
fever, Mr. Cole, brought the seeds of it in his body from
that place.
  On the 25th of the month, two members of the commit-
tee, lately appointed by the government of the  state,  for
taking care  of the health  of the city, called upon me to
know whether the yellow fever was in town.  1 told them
it was, and  mentioned some of the  cases that had come
under  my notice; but informed them,  at the same time,
that I had seen no case in which  it had been contagious,
and that, in  every case where I had been called early, and
where my prescriptions had been followed, the disease had
yielded to medicine.
  On  the 29th of the month,  I  received an  invitation to
attend a meeting of the committee of health,  at their office
in Walnut street.   They interrogated  me respecting the in-
telligence I had given to two of their members on the 25th.
I repeated it to them,  and mentioned the names of all the
persons I had attended in the yellow fever, since the 9th of
June.
  Neither this, nor several subsequent communications to
the  committee of health,  produced the effect that was  in-
tended by them.  Dr. Physick and Dr. Dewees supported
me  in my declaration, but their testimony did not protect
me from the clamours of my fellow-citizens, nor from  the
calumnies of some of my brethren, who, while they daily 
BILIOUS YELLOW FEVER OF 1794.       201
attended or lost patients in the yellow fever, called it by the
less unpopular names of
  1. A common intermittent. 2. A bilious fever. 3. An
inflammatory remitting fever. 4.  A putrid fever.  5. A ner-
vous fever.  6.  A dropsy of the brain.  7.  A lethargy. 8.
Pleurisy. 9. Gout.  10. Rheumatism. 11.  Colic.  12.  Dy-
sentery.  And 13.  Sore throat.
  It was said further,  by several of the physicians of the
city, not to  be the yellow fever, because  some  who had
died of it had not a sighing in the beginning, and a black
vomiting in the close of the disease.  Even  where the black
vomiting and yellow skin occurred,  they were said not to
constitute a yellow fever, for that those symptoms occurred
in other fevers.
  Let not the reader complain of the citizens and physi-
cians of Philadelphia alone.   A similar conduct has exist-
ed in all cities upon the  appearance of great and mortal
epidemics.
  Nor is it any thing new for mortal diseases to receive
mild and harmless  names from  physicians.   The plague
was called a spotted fever,  for several months, by some of
the physicians of London, in the  year 1665.
  Notwithstanding  the pains which  were taken to discredit
the report of the existence of the yellow fever in the city,
it was finally believed  by many citizens, and a number of
families in consequence of  it left the city.   And in spite of
the harmless names  of intermitting and remitting fever, and
the like, which were given to the  disease, the  bodies of
persons who had died of  it were conveyed to the  grave, in
several instances, upon a hearse,' the way  in which those
who died of the yellow fever were buried the year before.
  From  the influence of  occasional showers of rain, in the
months of September and October, the disease was fre-
quently checked, so as to disappear altogether for two or
three days in my circle of practice.   It was observed, that
while showers  of rain lessened,  moist or  damp weather,
without rain, increased it.
  The cold weather in October checked the fever, but did
not banish it from the city.  It appeared in November, and
in all the succeeding winter and spring months.  The wea-
ther, during these months, being uncommonly  moderate,
   v o l .  111.               c c 
202
AN ACCOUNT  OF THE
 will account for its not being destroyed at die time in which
 the disease usually disappeared in former years.
   The causes which predisposed to this fever  were the
 same  as  in the year 1793.  Persons of full habits, stran-
 gers, and negroes, were most subject to it.  It may  seem
 strange to those persons  who have read that negroes are
 seldom affected  with this fever  in the  West-Indies,  that
 they were so much affected by  it in Philadelphia.  There
 were two reasons for it.  Their manner of living  was as
 plentiful as that  of white people  in the West-Indies, and
 they  generally resided in alleys and on the skirts of the
 city, where they were more exposed to noxious exhalation,
 than in its more open and central parts.
   The summer fruits, from being eaten before they were
 ripe, or in too large a quantity, became frequently exciting
 causes of this fever.   It was awakened  in one of my pa-
 tients by  a supper of peaches and milk.  Cucumbers, in
 several instances, gave vigour to the miasmata which had
 been previously received into the system.  Terror excited
 it in two of my patients.  In one of them, a young woman,
 this terror was produced by hearing, while she sat at din-
 ner, that a hearse had passed by her door with a person on
 it who had  died of the yellow fever.   Vexation excited it
 in a foreign master of a vessel,  in consequence of a young
 woman suddenly breaking an engagement to  marry him.
 The disease terminated fatally in this instance.
   It was  sometimes unfortunate for patients when the dis-
 ease was excited by an article of diet, or by any other cause
 which acted suddenly upon the system; for it led bodi them,
 and in some instances their physicians, to confound those ex-
 citing causes with its  remote cause, and to view the disease
 without the least relation to the prevailing  epidemic.  It was
 from this  mistake that many persons were said to die of in-
 temperance, of eating ice creams, and of  trifling colds, who
 certainly  die^of the yellow fever.   The rum,  the ice
 creams, and the changes in the air, in all these cases, acted
 like sparks of fire which  set in motion the quiescent parti-
 cles of tinder or gunpowder.
   I shall  now  proceed to describe the  symptoms which
this fever assumed during the  periods  which have  been
mentioned.   This detail  will be interesting to physicians
who wish  to  see how little nature  regards  the  nosological 
BILIOUS YELLOW  FEVER OF  1794.
203
iirrangement of authors,  in the formation of the symptoms
of diseases, and how much the seasons influence epidemics.
A physician,  who had practised medicine near sixty years
in the city of Philadelphia, declared that he  had never seen
the dysentery assume the same symptoms in any two suc-
cessive years.  The same may be said  probably of nearly
all epidemic diseases.
  In the arrangement of the symptoms of this fever, I shall
follow the order I adopted in my Account of the Yellow
Fever of 1793, and describe them as they appeared in the
sanguiferous system, the liver, lungs,  and brain, the ali-
mentary canal, the secretions  and excretions, the  nervous
system, the senses and appetites, upon the skin, and in the
blood.
  Two premonitory symptoms struck me this year, which
I did not observe in 1793.  One  of  them was a frequent
discharge  of pale urine, for a day or  two before the com-
mencement of the fever; the other  was sleep unusually
sound, the night before  the attack of the fever.   The for-
mer  symptom  was a precursor of the  plague of Bassora,
in the year 1773.
  I.   I observed  but few symptoms in the  sanguiferous
system different from what I have mentioned  in the fever
of the preceding year.  The slow and intermitting pulse
occurred in many, and a pulse  nearly imperceptible, in
three instances.   It was seldom very  frequent.   In  John
Madge, an English farmer, who had just arrived in our ci-
ty, it beat only 64 strokes  in a minute, for several days,
while he was so ill as to require three bleedings a day, and
at no time of his fever did  his pulse exceed  96 strokes in a
minute.  In Miss Sally Eyre, the pulse at one time was at
176, and at another time it was at 140 ; but this frequency
of pulse  was very rare.   In a majority of the cases which
came under my notice, where the danger was great, it sel-
dom exceeded 80 strokes  in a minute.   I have been thus
particular in describing the frequency of the pulse, because
custom has created an expectation of that part of the history
of fc vers; but my attention was directed chiefly to the dif-
ferent degrees of force in the pulse,  as manifested by its
tension, fulness,  intermissions, and  inequality of action.
The hobbling pulse  was  common.  In  John Geraud,  I
perceived a quick stroke to succeed every two strokes of an 
204
AN  ACCOUNT OF THE
 ordinary  healthy pulse.   The intermitting,  chorded,  and
 depressed pulse occurred in many cases.   I called it the
 year before a sulky pulse.  One of my pupils, Mr. Alex-
 ander,  called it more properly a locked pulse.  I think 1
 observed this state of the pulse to occur chiefly in persons
 in whom the fever came on without a chilly fit.
    Haemorrhages occurred in all the grades of this fever,
 but less frequently in my practice this year than in the year
 before.   It occurred, after a ninth bleeding, in Miss Sally
 Eyre, from the nose and bowels.   It occurred  from the
 nose, after a sixth bleeding, in Mrs. Gardiner, who was at
 that  time  in the sixth   month of  her pregnancy.  This
 symptom, which was accompanied  by a tense and quick
 pulse, induced  me to repeat the  bleeding  a  seventh time.
 The blood  was  very sizy.  I  mention  this fact to establish
 the opinion that haemorrhages  depend  upon too  much
 action  in the blood-vessels,  and that they  are not occa-
 sioned by a dissolved state of the blood.
    There  was a disposition at this time to haemorrhage in
 persons who were in apparent good health.   A private,  in a
 company of volunteers commanded by Major M'Pherson,
 informed me that three  of his messmates were affected by
 a bleeding  at the nose, for several days  after they left the
 city, on their way to quell the insurrection of the western
 counties of Pennsylvania.
   II. The liver did not exhibit the usual marks of inflam-
 mation.   Perhaps my mode of treating the fever prevented
 those symptoms of hepatic affection which belong to  the
 yellow fever in tropical climates.  The lungs were frequent-
 ly affected; and hence the disease was in many instances
 called a pleurisy or a catarrh.  This  inflammation of  the
 lungs occurred  in a  more especial manner in the winter
 season.   It was distinguished  from the pleurisies of com-
 mon years by a  red eye,  by a vomiting of  green or yellow
 bile, by black stools, and by requiring  very copious blood-
 letting to  cure it.
   The head was affected, in this fever,  not  only w ith coma
 and delirium, but with  mania.   This symptom  was so
 common as to give rise to an opinion that madness was
 epidemic  in  our city.  I saw  no cause  of it which was
not connected with other symptoms of the bilious remit- 
          BILIOUS YELLOW  FEVER OF 1794.        205

ting fever.   The Rev. Mr. Keating, one of the ministers
of the Roman church, informed me that he had been call-
ed to visit seven deranged persons in his congregation,  in
the course of one week, in the month of March.  Two of
them had made attempts upon their lives.  This mania was
probably,  in each of the above cases, a symptom only  of
general  fever.   The dilatation of the pupil was universal
in this fever.
  Sore  eyes were common during the prevalence of this
fever.   In Mrs. Learning, this affection of the eyes was at-
tended with  a fever of a tertian type.
  III.  The  alimentary canal suffered as usual in this fever.
A vomiting  was common upon the first attack of the dis-
ease.  I observed this symptom  to be less common after
the cold and rainy weather which  took  place about the first
of October.
  I have in another place mentioned  the influence of the
weather upon the symptoms of this disease.  In addition to
the facts which have been formerly recorded,  I shall add
one more from Dr. Desportes.   He tells us,  that in dry
weather the disease affects the head, and that  the bowels
in this case  are more obstinately costive than in moist wea-
ther.  This influence of the atmosphere on the yellow fe-
ver will not surprise those physicians who recollect the re-
markable passage in Hippocrates, in which he says,  that in
the violent heats  in summer, fevers appeared,  but w ithout
any sweat;  but if a shower, though ever so slight, appear-
ed, a  sweat broke  out  in the beginning.*   I observed
further, that a vomiting  rarely  attended those cases  in
which there was an absence of a chilly  fit  in the beginning
of the fever.   The same observation is made by Dr. Des-
portes. f
  The matter discharged by  vomiting  was green or yellow
bile in most cases.   Mrs. Jones,  the wife of captain Lloyd
Jones,  and one other person, discharged black bile within
one hour after they  were attacked by the fever.  I have
taken notice, in the History of the Yellow Fever of  1793,
that a discharge of bile in the beginning of this fever was
always a favourable symptom.  Dr. Davidson, of St. Vin-
cents, in a letter to me,  dated the 22d July, 1794,  makes
• Epidemics, book XI. sect. I.
i U:s Maladies de St. Domingue, vol. I. p. 193. 
206
AN  ACCOUNT OF THE
the same remark.  It shows that the biliary ducts are open,
and that the bile is not in that viscid and impacted state
which is described in the dissections of Dr. Mitchel.*   A
distressing pain in the stomach, called by Dr. Cullen gas-
trodynia, attended in two instances.  A burning pain in  the
stomach, and a soreness to the touch  of its whole external
region,  occurred  in three  or four  cases.  Two  of them
were in March, 1795.  In Mrs. Vogles, who had the fever
in September, 1794, the sensibility of the pit of the stomach
was so exquisite, that she could  not  bear the weight of a
sheet upon it.
  Pains in the bowels were very common.  They formed
the true bilious  colic,  so often mentioned by West-India
writers.  In John Madge  these pains  produced a hardness
and contraction of the whole external region of the  bowels.
They were  periodical  in  Miss Nancy Eyre, and  in Mrs.
Gardiner, and in both  cases were attended with diarrhoea.
  Costiveness without pain was  common, and,  in some
cases, so extremely obstinate as to resist,  for several days,
the successive and alternated use  of all the usual purges of
the shops.
  Flatulency was less common in  this  fever than in  the year
1793.
  The  disease appeared with symptoms of dysentery in
several cases.
  IV.   The following is  an account of the state of  the
secretions and excretions in this fever.
  A puking of bile was more common this year  than in
the year 1793.   It was generally  of a green or yellow  co-
lour.  I have remarked before, that two of my patients dis-
charged black bile  within an hour after they were affected
by  the  fever, and  many  discharged  that kind  of matter
which  has been compared to coffee-grounds, towards  the
close of the  disease.
  The faeces were black  in most cases where  the symp-
toms of the highest grade of the fever attended.   In  one
very malignant case the most drastic purges brought away,
by  fifty evacuations,   nothing  but natural  stools.  The
purges were continued, and finally black faeces were dis-
* Quoted in the Account of the Yellow Fever of 1793. 
           BILIOUS  YELLOW FEVER Of  1794.       207

charged, which produced immediate relief.* In one person
the faeces were of a light colour.   In this patient  the yel-
lowness in the face was of an orange colour, and continued
so for several weeks after his recovery.
   The  urine was, in most cases, high coloured.   It was
scanty in quantity in Peter  Brown,  and totally  suppressed
in John Madge for two days.   I ascribed  this defect of na-
tural action in the kidnies to an engorgement in their blood-
vessels, similar to that  which takes  place  in the lungs and
brain in this fever.  I  had  for some time entertained this
idea of  a  morbid  affection of the kidnies,  but I have lately
been confirmed in it by the account which Dr. Chisholm
gives of the  state  of one of the kidnies, in a man whom he
lost  with the Beullam fever,  at Granada.   " The right
kidney  (says the doctor) was mortified,  although  during
his illness  no  symptom of inflammation  of  that  organ
was perceived."f  It woul<^l seem as if the  want of action
in the kidnies, and  a  defect in their functions, were  not
necessarily  attended with pain.   I  recollect  to have met
with  several cases in 1793, in which there was a total ab-
sence of pain in  a  suppression of urine of several days
continuance.  The same observe tion is made by Dr. Chis-
holm, in  his  account  of the Beullam fever of Granada.J
From this fact it  seems probable, that pain is not the effect
of any  determinate state of animal fibres, but requires the
concurrence of morbid  or preternatural excitement to pro-
duce it.  I  met  with  but  one case  of  strangury in this
fever.   It terminated  favourably in a few days.   I have
never seen death,  in a single instance, in  a  fever from any
cause, where a strangury attended, and I have seldom seen
a fatal issue  to a fever,  where this symptom was accident-
ally produced by a  blister.  From  this  fact there would
seem to be  a connexion  between a  morbid excitement in
the neck of  the bladder, and the safety of more vital parts
  • In the account of the effects of morbid action and inflammation, in  the
Outlines of Phenomena  of Fever, (p. 39,) the author has mentioned the change
of certain  fluids  from their natural to a bark colour. It appears in the secre-
tions of the stomach and bowels,  in the bile, in the urine, in carbuncles,  and
occasionally  in the matter, which is produced by blisters.  All these changes
occur in the yellow fever, and, in common with the other effects of fever that
have been enumerated,  are the result of peculiar actions in the vessels, derived
from one cause, viz. morbid excitement.
  j- Essay on the Malignant Pestilential Fever introduced into the West-Indies
from Beullam, p. 137.
  i Page 2^t 
208
AN ACCOUNT OF THE
of the bod)'.  The idea of this connexion was first sug-
gested to me, above thirty years ago, by the late Dr. James
Leiper, of Maryland, who informed me that he had some-
times cured the most dangerous cases of pleurisy, after the
usual remedies had failed,  by exciting a strangury, by
means of the tincture of Spanish flies mixed with cam-
phorated spirit of wine.
  The tongue was always moist  in the beginning of the
fever, but it was generally of a darker colour than last year.
When the disease was left to itself, or treated with bark and
wine, the tongue became of a fiery red colour, or dry and
furrow?ed, as in the typhus fever.
  Sweats were more common in the remissions  of this
fever, than they were in the year 1793, but they seldom
terminated  the disease.   During the course of the sweats,
I observed  a deadly coldness over the whole body to con-
tinue in several instances,  but without any danger or in-
convenience to the patient.   In two of the worst cases I at-
tended, there were remissions, but no sweats until the day
on which the fever terminated.  In several of my  patients,
the fever wore away without the least moisture on the skin.
The  milk,  in one case,  was of a greenish colour, such as
sometimes  appears  in the serum of the blood.   In another
female patient who gave suck, there was no diminution in
the quantity of her milk during the whole time of her fe-
ver, nor did her infant suffer the least injury from sucking
her breasts.
  I observed tears to flow from the eye of a young woman
in this fever,  at a time  when her  mind seemed free from
distress of any kind.
  V. I proceed next to mention  the symptoms of this fe-
ver in the nervous system.
   Delirium was less common than last year.   I was much
struck in  observing John Madge, who had  retained his
reason while he was so ill as to require  three bleedings a
day,  to become delirious as soon as he began to recover,
at which time his pulse rose  from between 60 and 70, to
96 strokes  in a minute.   I saw one case of extreme dan-
ger, in which a hysterical laughing and weeping alternately
attended.
   I have before  mentioned  the frequency of mania as a
symptom of this disease. An obstinate wakefulness attend- 
BILIOUS YELLOW FEVER OF 1794.
209
 ed the convalescence from this fever in Peter Brown, John
 Madge, and Mr. Cole.
   Fainting was more  common in  this fever than in  the
 fever of 1793,  It ushered in the  disease in one of  my
 patients, and it occurred in several instances after bleeding,
 where the quantity of blood drawn was very moderate.
   Several people complained of giddiness in the first attack
 of the fever, before they were confined to  their beds.
 Sighing was less common, but a hiccup was more so, than
 in the year before.
   John Madge had an  immobility in his limbs bordering
 upon palsy.   A weakness  in  the  wrist in one case suc-
 ceeded a violent attack of the fever.
   Peter Brown  complained of a most acute  pain in  the
 muscles of one of his legs.  It afterwards became so much
 inflamed as to require external  applications to prevent  die
 inflammation terminating in an abscess.   Mrs. Mitchell
 complained of severe cramps in her legs.
   The sensations of pain in this fever were often expressed
 in extravagant language.   The pain in the head, in a par-
 ticular manner,  was  compared to  repeated  strokes of a
 hammer upon the brain,  and in  two cases, in which this
 pain was accompanied by  great heat, it was  compared to
 the boiling of a pot.
   The more the pains were confined to the bones and back,
 the less danger was to  be apprehended from the disease.
 I  saw no  case of  death from  the yellow fever in 1793,
 where the patient  complained  much of pain in the back.
 It is easy to conceive how this external  determination of
 morbid action  should preserve more vital parts.   The bili-
 ous fever of 1780  was a harmless disease, only because it
 spent its whole force chiefly upon the limbs.   This was so
 generally the case,  that it acquired, from the pains in  the
 bones which accompanied it, the name of the " break bone
fever." Hippocrates has  remarked  that pains which  de-
 scend, in a fever,  are more favourable than  those which
ascend.* This  is  probably  true, but  I did  not  observe
 any such peculiarity in the translation of pain in this fever.
 The  following fact  from Dr. Grainger will add  weight
to the above observations.  He observed the pains in a
 malignant fever which were diffused  through the whole
                 * Epidemics, book ii. scot. }
     vol. in.            n d 
210
AN  ACCOUNT OF THE
head, though excruciating, were much less dangerous than
when they were confined to the temples or forehead.*.
   I saw  two cases in which a locked jaw  attended.  In
one of them it  occurred only during one paroxysm of  the
fever.  In both it yielded in half an hour to blood-letting.
I met with one  case in which there  was universal teta-
nus.  I  should  have suspected  this to  have been  the
primary  disease,  had not two persons been infected in the
same house with the yellow fever.
   The countenance sometimes put on a ghastly appearance
in the height of a paroxysm of the fever.   The face of a
lady, admired when in health for uncommon beauty, was
so much distorted by the commotions of her whole sys-
tem, in a fit of the fever,  as to  be viewed with horror by
all her friends.
   VI. The senses and appetites were affected in this fever
in the following manner.
   A total  blindness  occurred  in two persons  during the
exacerbation of the fever, and ceased during its  remissions.
A great intolerance of light occurred in several cases.   It
was most observable in John Madge during his convales-
cence.
   A soreness  in the sense of touch was  so exquisite, in
Mrs. Kapper, about the crisis of her fever,  that the pres-
sure of  a piece  of  fine  muslin upon her  skin gave her
pain.
   Peter Brown, with great heat in the  skin, and a quick
pulse, had no  thirst; but a most intense degree  of thirst
was very common in this fever.  It produced the same ex-
travagance of expression that I  formerly said  was produ-
ced  by  pain.   One of my patients,  Mr. Cole,  said he
" could  drink  up the ocean." I did not observe thirst to
be connected with any peculiar state of the pulse.
   George Eyre and Henry Clymer had an unusual degree
of appetite, just before the usual time  of the  return  of a
paroxysm of fever.
   A young man complained to me of being afflicted with
nocturnal emissions of seed during his convalescence. This
symptom is not a new one in malignant fevers. Hippocrates
takes notice of it.f  I met with one  instance of it among
  * Historia Febris Anomalse Batavx Annorum 1746, \747, 1748, cap. i.
  \ Epidemics, book IV. 
BILIOUS YELLOW FEVER OF 1794.
211
the sporadic cases of yellow fever which occurred in 1795.
It sometimes occurs, according to Lomius, in the commo-
tions of the whole system which take place in epilepsy.
   VII. The disease made an impression upon the lym-
phatic system.  Four  of my patients had glandular swel-
lings : two of them were in the groin ; a third was in the
parotid; and the fourth was in die maxillary glands.   Two
of these spellings suppurated.
   VIII. The  yellowness of the  skin,  which  sometimes
attends this fever, was more universal, but more faint than
in the year 1793.  It was, in many cases, composed of such
a mixture of colours, as  to  resemble polished mahogany.
But, in a few cases, the yellowness v/as of a deep orange
colour. The former went off with the fever; but the latter
often continued for several weeks after the patients recover-
ed.  In some instances a red colour predominated to such
a degree in the face, as to produce an appearance of inflam-
mation.                            %
   In Mrs. Vogles a yellowness appeared in her eyes during
the paroxysm of her fever, and went off in its remissions.
   In James Lefferty the yellowness affected  every  part of
his body, except  his  hands, which were as  pale as in a
common fever.
   Peter Brown tinged his sheets of a yellow colour,  by
night sweats, many weeks after his recovery.
   There was an  exudation  from the soles of the feet  of
Richard Wells's maid, which tinged a  towel of a yellow
colour.
   In my Account of the Yellow Fever  of 1793, I ascribed
the yellow colour of the  skin wholly to a mixture  of bile
with the blood.  I believe that  this  is the cause of it,  in
those cases where the colour is deep, and endures for several
weeks beyond the crisis of the fever: but where it is tran-
sitory, and, above all,  where it is local,  or appears only  for
a few hours, during the paroxysm of the fever, it appears
probable that it  is connected with the mode of aggregation
of the blood, and that it is produced wholly by some pe-
culiar action in  the blood-vessels.   A similar colour takes
place from the bite of  certain animals, and from contusions
of the skin, in neither of which cases has a suspicion been
entertained of an  absorption or mixture  of bile with the
blood. 
212              AN  ACCOUNT OF THE

  A troublesome itching, with an eruption of red blotches
on the skin, attended on the first  day  of the attack of the
fever, in Mrs. Gardiner.
  A roughness of the skin, and a disposition in it to peel
off, appeared about the crisis of the fever, in  Miss Sally
Eyre.
  That species of eruption, which I have elsewhere com-
pared to moscheto bites, appeared  in Mrs. Sellers.
  John  Ray, a day labourer, to whom I was called in the
last stage of the fever, had petechiae on his breast  the day
before he died.
  The  burning  heat on  the skin, called by the  ancients
" calor  mordens," and  from  which this fever, in  some
countries, has derived the name of causus, was more com-
mon  this year than last.   It was  sometimes  local, and
sometimes general.   I perceived  it in an exquisite degree
in the cheeks only of Miss Sally Eyre, and over the whole
body of John Ray. It <had no connection with the  rapidity
or force of the circulation of the blood in the latter instance,
for it was most intense at a time wThen he had no pulse.
  It is remarkable that the heat of the skin has no connec-
tion with the state of the pulse.   This fact did not escape
Dr. Chisholm.   He says he found the skin to be  warm
while the pulse was at 52, and that it was sometimes disa-
greeably cold when the pulse was as quick as in ordinary
fever.*
  IX.  I have in another place rejected putrefaction from
the blood as the cause or effect of this fever. I shall mention
the changes which were induced in its appearances when I
come to treat of the method of cure.
  Having  described  the  symptoms of this fever as they
appeared in different parts of the  body,  I shall now add a
few observations upon its type or  general character.
  I shall begin this part of the history of the fever by re-
marking, that wre had  but one reigning disease  in town
during  the autumn  and  winter;  that this was a bilious
remitting, or intermitting, and sometimes  a yellow fever;
and that all the fevers from other remote causes than putrid
exhalation, partook more or less  of the symptoms of the
prevailing  epidemic.  As well might  we  distinguish the
rain which falls  in gentle showers in Great-Britain, from
                        * Page 117. 
          BILIOUS YELLOW FEVER OF 1794.        213

that which is  poured in torrents from  the clouds  in the
West-Indies, by  different names and qualities, as impose
specific names and characters upon the different states of
bilious fever.
  The forms in which this fever appeared were  as follow,
  1. A tertian fever.  Several persons died of the third fit
of tertians, who were so well as to go abroad on  the inter-
mediate day of the fever.  It is no new thing for  malignant
fevers to put on the form of a tertian.   Hippocrates long
ago remarked, that intermittents sometimes  degenerate into
malignant acute diseases; and hence  he advises physicians
to be on their guard upon the 5th, 7th, 9th, and even on the
14th day of such fevers.*
  2. It appeared  most frequently in the form of a  remit-
tent.   The exacerbations  occurred most commonly in the
evening. In some there  were exacerbations in the morning
as well as in the evening.   But I met with several patients
who appeared to be better and worse half a dozen times in
a day.  In each of these cases,  there were  evident  remis-
sions and exacerbations of the fever.
  It assumed in several instances, the symptoms of a colic
and cholera morbus.  In one case the fever, after the colic
vvas cured, ended in a regular intermittent.  In another, the
colic was accompanied by a haemorrhage from the nose.  I
distinguished this bilious colic from that which   is excited
by  lighter causes,  by its always coming on with more or
less of a chilliness.f  The symptoms of colic and cholera
morbus occurred most frequently in  June and July.
  4.  It appeared in the form of a dysentery in a boy  of
William  Corfield,  and  in a man  whom my pupil, Mr.
Alexander, visited in  the neighbourhood of Harrowgate.
  5.  It appeared, in one case, in the form  of an apoplexy.
  6.  It disguised itself in the form of madness.
  7.  During the month of November, and  in all  the winter
months, it was accompanied with  pains  in the  sides and
breast, constituting what  nosologists call  the  "pleuritis
biliosa."
   8.  The puerperal fever was accompanied, during the
summer and autumn, with more  violent symptoms  than
usual.  Dr.  Physick informed me, that two women,  to
whom he was called soon after their deliver}-, died of ute-
  *  De Morb. Popular, lib. VIT.            f See Sydenham, vol. I. 212. 
214             AN ACCOUNT OF THE
 rine haemorrhages; and that he had with difficulty recovered
 two other lying-in women, who were afflicted with  that
 symptom of a malignant diathqsis in the blood-vessels.
    9. Even dropsies partook more or less  of the inflamma-
 tory and bilious character of this fever.
    10.  It blended itself with the  scarlatina.  The blood, in
 this disease, and in the  puerperal fever,  had exactly the
 same appearance that  it had in the yellow  fever.  A yellow-
 ness in the eyes accompanied the latter disease in one case
 that came under my notice.
    A slight shivering ushered in  the fever  in several instan-
 ces.  But  the worst cases  I saw came  on without a chiliy
 fit, or the least sense of coldness in any  part of the body.
    Such was the predominance of the intermitting, remitting,
 and bilious fever, that the measles, the small-pox, and even
 the gout itself, partook more or less of its  character. There
 were several instances in which  the measles, and  one in
. which the gout appeared with quotidian  exacerbations; and
 two'in which madness appeared regularly in the form of a
 tertian.
    I mentioned  formerly that this fever sometimes went off
 with a sweat, when it appeared in a tertian form. This was
 always the  case with the second  grade  of the fever,  but
 never with the first degree of it, before the third or fourth
 paroxysm ; nor did a sweat occur on the  fifth or  seventh
 day, except after the use of depleting remedies.  This pe-
 culiarity in the fever of this year was so fixed, that it gave
 occasion for my comparing it, in  my intercourse with  my
 patients, to a lion  on  the  first seven days, and  to a lamb
 during the remaining part of its duration.
   The fever differed from the fever of  the preceding year
 in an important particular. I saw or heard of no case which
 terminated in death on the first or third day.  In every case,
 the fever came on fraught with paroxysms. The moderate
 degrees of it were of so  chronic a nature as to  continue for
 several weeks, when left to  themselves.  I wish this pecu-
 liarity in the epidemic which I am now  describing  to  be
 remembered; for it wiil serve hereafter to  explain the reason
 why a treatment  apparently  different should be alike suc-
 cessful, in different seasons  and in different countries.
   The crisis of  the fever occurred on uneven days more;
 frequently than in the- fever  of the year-1793. 
          BILIOUS YELLOW  FEVER OF 1794.       215

   I  remarked  formerly* that remissions were more com-
mon in the yellow fever than in the common bilious fever.
The same observation applies  to critical days.   They were
observable in almost every case in which  the disease was
not strangled in its birth. Dr. Chisholm describes the same
peculiarity in die Buellam fever. " I have not met with any
disease (says the doctor) in which the  periods  were more
accurately ascertained, "f
   In addition to the instances formerly enumerated,^ of the
predominance of powerful epidemics over other diseases, I
shall add two more, which I have lately met with  in die
course of my reading.
   Dr. Chisholm, in describing the pestilential fever intro-
duced into the  West-Indies from Buellam, has the follow-
ing remarks.   " Most  other  diseases  degenerated into, or
partook very much of this. Dysenteries suddenly stopped,
and were immediately succeeded by the symptoms of the
pestilential fever.  Catarrhal   complaints,  simple at first,
soon changed  their nature; convalescents from other dis-
eases were very  subject to this,  but  it generally  proved
mild.   Those  labouring at the same time under chronic
complaints,  particularly rheumatism  and hepatitis, were
very subject to it. The  puerperal fever became malignant,
and of course fatal; and even  pregnant negro women, who
otherwise might have had it in the usual mild degree pecu-
liar to that description of people, were reduced to a very
dangerous situation by it. In  short, every disease in which
the patient was liable  to infection, sooner or later assumed
the appearance, and acquired the danger of the pestilential
fever. "§
   Dr. Desportes  ascribes the  same universal empire to the
yellow fever which prevailed in St. Domingo, in the sum-
mer of 1733.   "  The fever of Siam (says the doctor) con-
veyed an infinite number of men to the grave, in  a short
time;  but I saw but one woman who was attacked by it."
" The violence of this disease  was sucty that  it subjected
all other diseases, and reigned  alone.   This is the character
of all contagious and pestilential diseases.  Sydenham, and
before him Diemcrbroek, have remarked this oftheplague."||
   • Account of the Yellow Fever of 1793.           f Page ^41.
   i Account of the Yellow Fever in 1793.           § Page 129, HO
   |i Page 40, 41.' See also p.  Ill, 230, V-l  vol I 
 216             AM  ACCOUNT OF THE

   In Baltimore the small-pox in the natural way was at-
 tended with  unusual malignity and mortality, occasioned
 by its being combined with the reigning yellow fever.
   It  has  been urged as  an objection to the influence of
 powerful epidemics chasing away, or bleeding with fevers
 of inferior force, that the measles  sometimes  supplant the
 small-pox, and mild intermittents take the place of fevers
 of great malignity.  This fact did  not escape the micros-
 copic eye of Dr. Sydenham, nor  is it difficult to explain
 the cause  of  it.  It  is well  known that  epidemics, like
 simple fevers, are most violent at their first appearance, and
 that.they gradually lose their force as they disappear; now
 it is in their evanescent and feeble state, that they are jostled -
 out of their  order  of danger or force, and  yield to the
 youthful strength of epidemics, more feeble  under  equal
 circumstances  of  age than  themselves.  But  admitting,
 powerful epidemics do not lose any part of their force by
 their duration, the system from habit, loses its susceptibi-
 lity to their action to such a degree, as to yield to the new
 impressions of such as are of a more feeble nature.   From
 this change in the character of violent epidemics, they have
 been said to invade with the fury of a savage, and to  retire
 with the gentleness of a civilized foe.
   It is agreeable to discover from these  facts and observa-
 tions, that epidemic diseases, however irregular they appear
 at a first sight, are all subject to certain laws, and partake
 of the order and harmony of the universe.
   The action  of the miasmata upon the body, when from
 the absence of an  exciting cause, they  did  not produce
 fever, was the same as I  have elsewhere described.   The
 sensations which I experienced, in entering a small  room
 where a person was confined with this fever, were so exactly
the same with those I felt the year before, that I think I
 could have distinguished the presence of the disease  with-
 out the assistance of my eyes, or  without  asking a single
question.   After sitting a few minutes in  a sick room, I
became languid and  fainty.  Weakness  and chilliness fol-
lowed every  visit I paid  to  a gentleman at Mr. Oeller's
hotel, which continued for half an hour.   A burning in my
stomachy great heaviness, and a slight inflammation  in my
eyes,  with a constant discharge of a  watery humour  from
them  for two  days, succeeded the first visit I paid to  Mrs. 
BILIOUS YELLOW  FEVER OF  1794.
217
Sellers. These symptoms came on in less than ten minutes
after I left her room.   They  were probably excited thus
early, and in the degree which I have mentioned, by my
having  received her breath in my face by inspecting her
tonsils,  which were ulcerated on the first attack of the fever.
I formerly supposed these changes in my body were proofs
of the  contagious  nature of the yellow fever, but I shall
hereafter explain them upon other principles.
  1 recollect having more than once perceived a smell which
had been familiar to me during the prevalence of the yellow
fever in 1793.  It resembled the smell of liver of sulphur.
I suspected for a while that it arose from the exhalations  of
the gutters of the city.  But an accident taught me that it
was produced by the perspiration of my body. Upon rub-
bing my hands, this odour was increased so as to become
not only more perceptible to myself, but in the most sensi-
ble degree to my pupil, Mr. Otto.  From this fact, I was
convinced that  I was strongly impregnated with miasmata,
and I was led by it to live chiefly upon vegetables, to drink
no wine,  and to avoid,  with double care, all the usual ex-
citing causes of fever.
  There  was another mark by which I distinguished the
presence of the seeds of this fever in my system, and that
was, wine imparted a burning sensation to my tongue and
throat,  such as is felt after  it has been taken  in excess,  or
in the beginning of a fever. Several persons, who were ex-
posed to  the miasmata, informed me that  wine, even  in
the smallest quantity, affected  them exactly in  the same
manner.
  I attended  four persons in this fever who had had it the
year before.
  It remains now that  I mention the origin of this fever.
This was  very  evident.,   It was produced by the exhala-
tions from the gutters,  and the stagnating ponds of water
in the neighbourhood of the city.   Where there was most
exhalation, there were  most persons affected by the fever.
Hence the poor people, who generally live in die neighbour-
hood of the ponds in the suburbs, were the greatest suffer-
ers by  it.   Four persons had the fever in Spruce, between
Fourth and Fifth-streets, in which part of the city the smell
from the  gutters was  extremely offensive  ever}- evening.
In Water-street, between Market and Walnut-streets, ma
   vol. in.                i  e 
218              AN  ACCOUNT OF THE

ny persons had the fever :  now the filth of that  confined
part of the city is well known to every citizen.
  I have before remarked, that one reason why most of our
physicians refused  to admit the presence of the  yellow
fever  in the city, was because  they could  not fix upon a
vestige of its being imported.  On the 25th of August, the
brig Commerce arrived  in the river, from St. Mark, com-
manded by captain Shirtliff.  After lying five days  at the
fort, she came up to the city.   A boy, who had been shut
out from his lodgings, went, in a state of intoxication, and
slept on her deck, exposed to the night air,  in consequence
of which the fever was excited in him.   This event gave
occasion,  for a few days, to a report  that the disease was
imported, and several of the physicians, who had neglected
to attend to all the circumstances that have been stated, ad-
mitted the yellow fever to be in town.  An investigation of
this supposed origin of the disease soon discovered that it
had no foundation.  At the time of the arrival of this ship,
I had attended nearly  thirty persons with die fever, and up-
wards of  a hundred  had had it, under  the  care of other
physicians.
  The generation of  the yellow fever in  our city  was ren-
dered more certain by the prevalence of bilious diseases in
every part of the United States, and, in several of them, in
the grade of yellow fever.  It was  common in  Charles-
ton, in South-Carolina, where  it carried off many people,
and where no suspicion was  entertained  of its  being of
West-India origin.   It prevailed with great mortality at
that part of the city of Baltimore, which is known by the
name of Fell's Point, where, Dr. Drysdale assures me, it
was evidently generated. A few sporadic cases of it occur-
red in New-York, which were produced by the morbid ex-
halation from  the docks of that city.   Sporadic cases of it
occurred likewise in most of the states, in which the proofs
of its being generated were'obvious  to common observa-
tion ;  and where the symptoms of depressed pulse, yellow-
ness of the skin, and  black discharges from the bowels and
stomach (symptoms  which mark the highest grade of bili-
ous remitting fever)  did not occur,  the fevers in all their
form  of tertian, quotidian, colic, and dysentery,  were ui>
commonly obstinate or fatal in every state in the Union.  In
New-Haven only, where the yellow fever was epidemic, it 
BILIOUS YELLOW FEVER OF 1794.
219
was said to have been imported from Martinique,  but this
opinion was proved to be erroneous by unanswerable docu-
ments, published afterwards in the Medical Repository, by
Dr. Elisha Smith, of New York.
   The year 1795 furnished several melancholy proofs of the
American origin of the yellow fever.  All the physicians
and citizens of New-York  and Norfolk  agree in its having
been generated in their  respective cities that year.   It pre-
vailed  with great mortality at the same  time in the neigh-
bourhood of the lakes,  and on the waters of the Genesee
river, in the state of New-York.  From its situation it ob-
tained the name of the lake and Genesee fever.  It was so
general,  in some parts  of that new  country, as to affect
horses.
   Thus have I endeavoured to fix the predisposing and re-
mote causes of the yellow fever in our country. The remote
cause is sometimes so  powerful  as to become an  exciting
cause of the disease, but in general  both  the predisposing
and remote causes are harmless in the system, until they be
roused into action by some exciting cause.
   I shall conclude this account of the symptoms and origin
of the yellow fever, by relating two facts, which serious and
contemplating minds will apply to a more interesting subject.
   1.  Notwithstanding  the numerous proofs of  the preva-
lence of the yellow fever-in Philadelphia in the year 1794,
which  have been mentioned, there are many thousands of
our citizens,  and a majority of our physicians, who do not
believe that a case  of it existed at that time in the city  ;
nor is  a single record  of it to be met with in any of the
newspapers, or other public documents  of that fever.  Let
us learn from this fact, that the denial of events,  or a gene-
ral  silence upon the  subject  of  them,  is no, refutation of
their truth, where they opposed the pride or interests of the
learned, or the great.
  2.  Notwithstanding the general denial of the existence
of the yellow fever in Philadelphia, and  the silence observ-
ed  by  our newspapers  relative to it in 1794,  there was
scarcely a citizen or physician who, three years afterwards,
did not admit of its having prevailed in that year.  We
learn from this fact another important truth, that departed
vice and error have  no friends nor advocates. 
220              AN ACCOUNT OF THE
          OF THE  METHOD OF CURE.


   THE remedies employed for the cure of this fever were
the same that I employed the year before.   1 shall only re-
late such effects of them as tend more fully to establish the
practice adopted in the year 1793, and such as escaped my
notice in  my former remarks upon those remedies.   My
method of cure consisted,
   I.  In the abstraction of the stimulus of blood and  heat
from  the whole body, and of bile and other acrid humours
from  the bowels,  by means of the following remedies:
      1.  Bleeding.
     2.  Purging.
     3.  Cool air and cold drinks.
     4.  Cold  water applied to  the external parts of the
          body and to the bowels by means of clysters.
   II. In creating a diversion of  congestion, inflammation,
and serous effusion,  from the brain and viscera to the mouth
by means of a salivation, and to the external parts of the
body  by means of blisters.
   III. In restoring  the strength of the system,  by tonic re-
medies.
   I proceed to make a few remarks upon the remedies set
down under each of the above heads.
   I.   I have taken  notice that this fever differed from the
fever of 1793, in  coming forward in July and August with
a number of paroxysms,  which refused to yield to purging
alone. I therefore began the cure of every case I was call-
ed to by bleeding.
   I shall mention the effects  of this remedy, and the  cir-
cumstances, manner, and degrees in which I used it occa-
sionally,  in this  fever,  in  my defence  of Blood-letting.
Under the present head I shall only  furnish the reader with
a table of the quantity of blood drawn from a  number of
my patients in-the course of the disease.  From several of
them  the quantity set down was  taken in three, four,  and
five days.   I shall afterwards  describe the appearances of
the blood. 
BILIOUS YELLOW FEVER OF 1794.       221
Month.	Patients.	Quantity ounces.	Number of' times bled.
August.	Peter Denham,	50	5
	Mrs. Bruce,	70	8
	Andrew Gribble,		
	aged 15 years, John Madge, Peter Brown,	50 150 80	5 12 8
September.	Mrs. Gardiner,	80	7
	Miss Sally Eyre,	80	9
	Mrs. Gass,	50	3
	Richard Wells's		
	maid,	100	10
	Mr. Norval,	100	9
	Mr. Harrison,	90	9
October.	Henry Clymer, Mrs. Mitchell,	80 120	8 13
	Mrs. Lenox,	80	7
	Mrs. Kapper, Rev. Dr. Magaw's	140	11
	maid,	100	10
	Miss Hood,	100	10
1795	Mrs. Vogles, Guy Stone,	70 100	5 9
January.	Benj. Hancock, Mr. Benton,	100 130	10 13
	Mrs. Fries,	150	15
	Mrs. Garrigues,	80	7
  Three of the women,  whose names I have  mentioned,
were in the advanced stage of pregnancy, viz. Mrs. Gardi-
ner, Mrs. Gass, and Mrs. Garrigues.   They have all since
borne healthy children.  I have omitted the names of above
one hundred persons who had the fever, from whom I drew
thirty or forty ounces of blood, by two or three bleedings.
I did not cure a single person without at least one bleeding.
  It  is only by contemplating the  extent in which it is ne-
cessary to use this remedy, in order to overcome a  yellow
fever, that we can acquire just ideas of its force.  Hitherto
this force has been estimated by no other measure than the 
 222             AN ACCOUNT OF  THE

 grave, and this, we know, puts the strength of diseases upon
 a level.
   The blood drawn in this fever exhibited the following ap-
 pearances.
   1.  It was dissolved in a few instances.
   2.  The crassamentum of the blood was so partially dis-
 solved in the serum, as to produce an appearance in the se-
 rum resembling the washings of flesh in water.
   3.  The serum was so lightly tinged of a red colour as to
 be perfectly transparent.
   4.  The serum was,  in many cases, of a deep yellow co-
 lour.
   5.  There was, in every case in which the blood was not
 dissolved, or in  which the second appearance that has been
 mentioned did not take place, a beautiful scarlet-coloured
 sediment in the bottom of the bowl, forming lines,  or a large
 circle.  It seemed to be a tendency of the blood  to disso-
 lution.  This state of the blood occurred in almost all the
 diseases of the two last years, and in some  in which there
 was not  the least suspicion of the miasmata of the yellow
 fever.
   6.  The crassamentum generally  floated  in the serum,
 but it sometimes sunk to  the bottom of the bowl. In the
 latter case the serum had a muddy appearance.
   7.  I saw but  one case in which there was not  a separa-
 tion of the crassamentum and serum of the blood. Its co-
 lour in this case was of a deep scarlet.  In the year 1793
 this appearance was very common.
   8.  I saw one case in which the blood drawn, amounting
 to 14 ounces,  separated partially,  and was of a deep black
 colour.   This blood was taken from Mr. Norval,  a citizen
 of North-Carolina.
   9.  There was, in  several  instances,  a  transparent jelly-
 like pelicle which covered the  crassamentum of the blood,
 and which was easily separated  from it without altering its
 texture.  It appeared to have no connexion with the blood.
   10.  The blood, towards the crisis of the fever  in many
people, exhibited  the  usual forms of inflammatory crust.
 It  was cupped in many instances.
   11. After the  loss  of 70 or 80 ounces of blood there was
 an evident disproportion of the quantity  of crassamentum 
          BILIOUS YELLOW FEVER OF 1794.       223

to die serum.   It was sometimes less, by one half, than in
the first bleedings.
   Under this  head it will be proper to mention that  the
blood,  when it happened to flow along the external part of
the arm in falling into the bowl,  was so  warm  as to excite
an unpleasant sensation of heat in several patients.
   To the appearances exhibited  by the blood to the eye, I
shall add a fact communicated to me by  a German bleeder,
who followed his business in the city during the prevalence
of the fever in 1793.   He informed me that he could dis-
tinguish a yellow fever from all  other states of  fever, by a
peculiar smell which the blood emitted  while  it was flow-
ing from a vein.  From the certainty of his decision in  one
case which came under my notice, before a suspicion  had
taken place of the fever being in the city, I am  disposed to
believe  that  there is a foundation for his remark.
   II. I have but little to add to the  remarks I  made upon
the use of purging in the year  1793. I gave jalap, calomel,
and gamboge,  until I obtained large  and  dark-coloured
stools;  after which I kept the bowels gently open every day
with castor  oil,  cremor tartar,  or Glauber's  salts.   I gave
calomel in much larger quantities than I  did the year before.
John Madge took nearly  150  grains of it in six days.  I
should  have thought this a large quantity, had  I not since
read that Dr. Chisholm gave 400 grains of it to one patient
in the course of his fever, and  50 grains to another at a  sin-
gle  dose, three times a  day.   I  found strong mercurial
purges  to be extremely useful in the winter months, when
the fever put on symptoms of pleurisy.   I am not singular
in  ascribing much to the efficacy  of purges in the bilious
pleurisy.  Dr. Desportes tells  us that he found the pleurisy*
of St. Domingo, which was of a bilious kind, to end happi-
ly in proportion as the bowels were kept constantly open.*
Nor am I singular in keeping my eye upon the original type
of a disease, which only changes its symptoms with the wea-
ther or the season, and in treating it with the same remedies.
Dr. Sydenham  bled as freely  in the diarrhoea of 1688, as
he had done  in the inflammatory fever of the preceding
year.f   How long the pleurisies of  winter,  in the city of
Philadelphia,  may continue to retain the bilious symptoms
• Page 140
•j- Wullib\ edition, p 211. vol. i. 
224              AN ACCOUNT OF  THE

of autumn, which they have assumed for three years past,
I know not; but the late Dr. Faysseaux, of South-Carolina,
informed me, that for many years he had not seen a pleuri-
sy in Charleston with the common inflammatory symptoms
which characterised that disease when he was a student of
medicine. They all now put on bilious symptoms, and re-
quire strong purges to cure them.  The pleurisies which the
late Dr. Chalmers supposes he cured by purging were pro-
bably nothing but bilious fevers, in which the cool weather
had excited some pleuritic symptoms.
  3. I have nothing to add to the remarks I have elsewhere
published upon the efficacy of cool air and cool drinks in
this  fever.  They were both equally pleasant and useful,
and contributed,  with cleanliness, very  much to the suc-
cess of my practice.
  4. Cold water, applied to the external parts of the body,
and  injected into the bowels by way of clyster, did great
service in many cases. John Madge found great relief from
clothes dipped  in cold water,  and applied to the lower part
of his belly. They eased a pain in his bowels, and procured
a discharge of urine.   A throbbing and most distressing
pain in the head was relieved by the same remedy, in Mrs.
Vogles and Mrs. Lenox.  The cloths  were  applied for
three successive days and nights to Mrs. Lenox's  head,
during an inflammation of her brain, which succeeded her
fever,  and were changed,  during the greater part of the
time, every ten  or fifteen minutes.  In 1795,  I increased
the coldness of pump water,  when used in this way, by
dissolving ice in it, and in some cases I applied powdered
ice in a bladder to the head, with great advantage.
   The following facts will show the good effects of cold
water in this, as well as other fevers of too much action.
  In the afternoon of one of those days  in which my sys-
tem was  impregnated  with  the  miasmata of  the yellow
fever, I felt so  much indisposed that I deliberated whether
I should go to  bed or visit a patient about a mile in the
country.  The afternoon was cool and rainy.  I recollected,
at this time, a case related by Dr.  Daignan, a French phy-
sician,  of a man who was cured of the plague, by  being
forced to lie all  night in an open field, in a shower of rain.
I got into my  chair,  and  exposed myself to the rain.  It
was extremely  grateful to my feelings.   In two hours  I 
          BILIOUS YELLOW FEVER OF  1794.      225

returned, when,  to my great satisfaction,  I  found all my
feverish symptoms had lett me, nor had I the least return
of them afterwards.
  Dr. Caldwell,  who  acted as a surgeon of a regiment, in
the expedition against the  insurgents in the western coun-
ties of Pennsylvania, furnished me, in a letter dated from
Bedford, October  20th, 1794, with an account of his hav-
ing been cured of a fever, by a  more copious  use  of the
same remedy.   " I was (says the doctor) to use a vulgar
expression, wet  to the skin, and had no opportunity of
shifting my clothes  for  several hours.  In  consequence
of this thorough  bathing, and by subsequent exposure to
a cool air, I was  relieved from  every symptom of indispo-
sition in a few hours, and have enjoyed more than my usual
stock of health ever since."
  The efficacy of  cold water, in preventing and curing in-
flammation, may be conceived  from  its effects when used
with mud or clay,  for obviating the pain  and inflammation
which  arise from  the sting of venomous insects.   The
same remedy, applied for half an hour, has lately, it is said,
been equally effectual in preventing the deleterious effects
of the bite of a rattle-snake.
  II. The good effects I had observed from the salivation
in the  yellow fever of 1793, induced me  to excite  it as
early as possible, in all those cases which did not  yield im-
mediately to  bleeding and purging.   I was delighted with
its  effects  in  every cast  in which it took place.  These
effects were as follow:
  1.  It immediately attracted and concentrated in the mouth
all the scattered  pains of every part of the body.
  2.  It checked a nausea and vomiting.
  3.  It gradually, when  it was copious, reduced the pulse,
and thereby prevented the necessity of further bleeding or
purging.
  I wish it w ere possible to render the use of this remedy
universal in the  treatment of malignant fevers. Dr. Chis-
holm, in his account of the Beullam fever, has done much
to establish its safety and efficacy.   It is a rare occurrence
for a patient that has been sufficiently bled and purged, to
die after a salivation takes place.   The artificial disease ex-
cited by the mercury suspends or destroys disease in every
part of the body.   The  occasional  inconveniences which
   vol. m.               r f 
226
AN ACCOUNT  OF  THE
attend it are not to be named with its certain and universal
advantages.  During the whole of the season in  which the
yellow lever prevailed, I saw but  two instances in which it
probably loosened  or  destroyed the  teeth.  I am not cer-
tain that the  mercury was  the cause of the injury or loss
of those teeth: for who has  not seen malignant fevers ter-
minate in ulcers, which have ended in the erosions of bony
parts of the body ?
   It  has been justly remarked,  that there can be but one
action at a time in the blood-vessels.   This was frequently
illustrated  by the manner in  which mercury acted upon the
system in  this fever.   It seldom salivated until the fever
intermitted or  declined.   I  saw several cases in wrhich the
salivation came . on  during the intermission, and went off
during its  exacerbation;  and many,  in which there  was  no
salivation until  the morbid action had ceased altogether in
the blood-vessels, by the solution of the fever.  It is be-
cause the  action of the vessels, in epilepsy and pulmonary
consumption, surpasses the  stimulus of the mercury, that
it is so difficult to excite a  salivation  in both  those dis-
eases.
   Let not  the advocates for  the healing powers of nature
complain of  a salivation as an unnatural remedy in fevers.
Dr. Sydenham  speaks in high terms of it, in the fever of
1670, 1671,  and 1672, in which cases it occurred sponta-
neously, and says that it cured it when it was so malignant
as to be accompanied  by  purple spots on the body.*
   Blisters, when applied  at a proper  time, did great service
in this fever.   This time was, when the fever was so much
weakened  by evacuations, that the artificial pain excited by
the stimulus of the blisters  destroyed, and, like a conduc-
tor,  conveyed off all the natural  pain of the body.  It is
from ignorance, or inattention to the  proper stage of fevers
hi which blisters  have been  applied, that there  have been
so many disputes among  physicians  respecting their effica-
cy.   When applied in a  state of great arterial action, they
do harm ;  when applied after that action has nearly ceased,
they do little or no service.   I have  called the  period  in
which blisters are useful the blistering point.   In  bilious
fevers this  point is generally circumscribed within eight and
forty hours.
  The effects of blisters were as follow-:
* Vol. ii. p. 212. 
          BILIOUS  YELLOW FEVER OF  1794.      227

   1.  They concentrated, like a salivation, all the scattered
 pains of the body, and thereby,
   2.  Reduced the pulse in force and frequency.
   3.  They  instantly  checked  a sickness at the stomach
 and vomiting.
   4.  They often induced a gentle moisture upon the skin.
   I found it of little consequence to  what part of the body
 the blisters were applied; for I observed a pain in the head,
 and even delirium,  to be as  speedily and certainly cured
 by blisters upon the wrists, as they were by a large blister
 to the neck.
   III. After die reduction of  the  morbid action of the
 blood-vessels, by means of the remedies which have been
 mentioned, I seldom made use  of any other  tonic than  a
 nourishing and gently stimulating diet.  This consisted of
 summer fruits, bread and milk,  chicken  broth,'  the white
 meats,  eggs,  oysters,  and malt liquors, more especially
 porter.   I made many attempts to cure this fever when  it
 appeared in the  form  of  a  simple  intermittent,  without
 malignant symptoms, by means of bark, but always, except
 in two  instances, without success ;  and in them it did not
 take effect until after bleeding.  In several cases it evidently
 did harm.   I  should have suspected my judgment in these
 observations respecting this medicine, had I not been assur-
 ed by Dr. Griffits,.Dr. Physick, and Dr.  Woodhouse, that
 it was equally ineffectual in their practice, in nearly all the
 cases in which they gave it, and even where  blood-letting
 had been premised.  Dr. Woodhouse saw  a  case in which
 nearly a pound of bark had been taken without effect; and
 another  in which a fatal  dropsy succeeded its  use.  Dr.
 Griffits  excepted, from his testimony against the bark, the
 cases of seven persons from the country, who  brought the
 seeds of the intermitting fever with  them to the city.  In
 them the bark succeeded without previous bleeding.   The
 facility with which these seven cases of intermitting fever
 were cured by the bark, clearly proves  that fevers of the
 same season differ very much,  according to the nature of
the exhalation which excites them.   The  intermittents  in
 these strangers  were excited by miasmata  of less force
than that which was generated  in our city, in which, from
the greater heat of the atmosphere, and the more heteroge-
neous nature of the putrid matters which stagnate in our 
228              AN ACCOUNT OF THE
ponds and gutters, the exhalation probably possesses a more
active and stimulating quality.  Thus the mild remittents
in June, and in the beginning of July, which were produ-
ced by the usual filth of the streets of  Philadelphia, in the
year 1793, differed very much from the malignant remitting
yellow fever which was produced by the stench of the putrid
coffee a few weeks afterwards.
   Sir John Pringle long ago taught the inefficacy  of bark
in certain bilious fevers. But Dr.  Chisholm has done great
service to medicine by recording its  ill effects in die Beul-
lam fever. " Head-ach  (says the doctor,) a heavy dull eye,
with a considerable protrusion from its orbits, low spirits,
thirst, and a total want  of appetite, were the general conse-
quences of the treatment with  bark  without the previous
antiphlogistic."
   I have mentioned a case of internal dropsy of the brain
having been produced by the improper use of the bark, in a
son of Mr. Coates.  I have  no doubt  but this disease, as
also palsy and consumption,  obstructions of  the liver and
bowels, and dropsies of the belly and  limbs, are often indu-
ced  by  the use of the bark, during an inflammatory state of
the blood-vessels.  It is to be lamented that the association
of certain diseases and remedies, in the minds of physicians,
becomes so  fixed, as to refuse to yield to the influence of
reason.   Thus pain and opium, dropsy and foxglove, low
spirits and assafoetida, and above all,  an intermitting fever
and  bark, are all connected together, in common practice,
as mechanically as the candle  and the snuffers are in the
mind of an old and  steady house  servant.   To abolish the
mischief of  these mechanical associations in medicine,  it
will  be necessary for physicians to prescribe only for  the
different states of the system.
   Finding the bark to be so universally ineffectual or hurtful,
I substituted col umbo root, the  carribean bark, arid several
other bitters, in its  place, but without success.   They did
less harm than the Jesuit's bark, but they did not check the
return of a single paroxysm of fever.
   I know that bark was given in this fever in some instan-
ces in which the patients recovered ; but they were subject,
during the winter, and in  the following spring, to frequent
relapses, and in some instances, to affections of the  brain
and lifngs.  In the  highest grade  of  the fever it certainly 
          BILIOUS  YELLOW FEVER, OF  1794.      229

accelerated a supposed putrefaction of the blood, and pre-
cipitated death. The practice of physicians who create this
gangrenous state of fever by means of the bark, resembles
the conduct of a horse; who attempts by pawing to remove
his shadow in  a stream of water, and thereby renders it so
turbid that he is unable to drink it.
   Should the immediate success of tonic and depleting
medicines in destroying the fever be equal, the effects of the
former upon the  constitution cannot fail of being less safe
than the  latter  remedies.   They cure by overstraining the
powers of life.  There  is the same difference, dierefore,
between the two  modes of practice, that there  is  between
gently lifting the latch of a door, and breaking  it  open,  in
order to go into a house.
   Wine was hurtful in every case of yellow fever in which
it was given, while there were any remains of inflammatory
action in the system. I recollect that a few spoonsful of it,
which Mr. Harrison of Virginia took in the depressed state
of his pulse, excited a sensation in his  stomach which he
compared to a fire.  Even wine-whey, in the excitable state
of the system induced by this fever, was sometimes hurtful.
In a patient of Dr. Physick, who was on  the recovery,  it
produced a relapse that had nearly proved  fatal, in the year
1795.   Dr. Desperrieres  ascribes the death of  a patient .to
a small quantity of wine  given  to him by  a black nurse.*
These  facts are important, inasmuch as  wine is a  medicine
which patients are most apt to use in all cases,  without the
advice of a physician
   I observed  opium to  be less  hurtful in  this fever than it
was in  the fever of  1793.   I administered a few drops of
laudanum, in one case, in the form of a clyster,  in a violent
pain in  the  bowels, with evident advantage, before the in-
flammatory action of the blood-vessels  was subdued.  In
this  way I  have often  obtained the composing  effects of
laudanum where it has been rejected by the stomach. But
I gave it  sparingly, and in  small doses only,  in the early
stage of the fever.  John Madge,  whose pains in his bowels
were often as exquisite as they  are in the most  acute Colic,
did not take a single drop of it.   I used no anodyne in  his
case but bleeding, and  applications of cold water to  the
inside and outside of his bowels.  After the fever had passed
                      • Vol. ii. p. 103. 
230
AN  ACCOUNT  OF THE
the seventh day, and had been so far subdued by copious
evacuations as to put on the form of a common inflamma-
tory intermittent, I gave laudanum during the intermissions
of the fever with great advantage. In some cases it sudden-
ly checked the paroxysms of the fever, while in many more
it only moderated them,  but in such a manner that they
wore themselves away in eight or ten  days.  One of my
female patients, who had taken bitters of every kind with-
out effect to cure a tertian, which succeeded a yellow fever,
took a large dose of laudanum, in the interval of her parox-
ysms, to cure a tooth-ach. To her great surprise it remov-
ed her tertian.  The effects of laudanum in this fever were
very different from those of bark. Where it did no service
it did not, like the bark, do any harm.
   Perhaps this difference in  the operation of  those  two
medicines depended  upon the bark acting with an astrin-
gent, as well  as stimulating power, chiefly  upon the blood-
vessels, while the action of opium was more simply stimu-
lating, and diffused at the same time over all the systems of
the body.
   I shall say in another place that I sometimes directed a
few drops of laudanum to be  given in  that state of extreme
debility which succeeds a paroxysm of the fever, with evi-
dent advantage.
   Nitre, so useful in common inflammatory fevers, was in
most cases so offensive to the stomach in this fever,  that I
was seldom able to give it. Where the stomach retained it
I did not perceive it to do any service.
  Antimonials were as ineffectual as nitre in abating the
action of the sanguiferous system, and in producing a sweat.
I should as soon expect to compose a storm by music, as
to cure the yellow fever by such feeble remedies.
  Thus have I finished the history of the symptoms, origin,
and cure of the yellow fever as it appeared in  Philadelphia
in 1794,  and in the winter of 1795.  The efficacy of the
remedies which  have been mentioned was established by
almost universal success.  Out of upwards of 200 patients
to whom I was called on the first stage of the fever, be-
tween the 12th of June, 1794, and the first of April,"  1795,
I Jost but four persons, in whom the unequivocal symp-
toms had occurred, which characterize  the first grade of
the disease. 
          BILIOUS YELLOW FEVER OF 1794.       231

   It will be useful, I hope, to relate the cases of the patients
whom I lost, and to mention the causes of their deaths. The
first of them was Mrs. Gavin. She objected to a fifth bleed-
ing in the paroxysm of  her fever, and died  from the want
of it.  Her death was  ascribed  to the frequency  of her
bleedings by the enemies of the depleting system.  It was
said that she had been bled ten times, owing to ten marks
of a lancet having been discovered on her arms after death,
five of which were occasioned by  unsuccessful attempts to
bleed her. She died with the usual symptoms of congestion
in her brain.
   Mr. Marr, to whom I was called on  the first day  of his
disease, died in a paroxysm of  his fever which came  on in
the middle of  the  seventh  night after six bleedings.  I had
left him, the  night before,  nearly free of fever, and in
good  spirits.  He might probably have been saved (humanly
speaking) by  one  more bleeding  in the exacerbation of
what appeared to be the critical paroxysm of his fever.
   Mr. Montford  of the state of  Georgia, died under the
joint care of Dr. Physick and  myself.  He had been  cured
by plentiful bleeding and  purging, but had relapsed.  He
appeared to expire in a fainty fit, in the first stage of a pa-
roxysm of the fever. Death from this cause (which occurs
most  frequently where blood-letting is not used) is common
in the yellow fever of the West-Indies.   Dr. Bisset, in
describing the different ways in which the disease terminates
fatally, says,  " In a few cases  the patient is carried off by
an unexpected syncope."*
   A  servant of Mr. Henry Mitchel, to  whom I was  called
in the early stage of his disease,  died in consequence of a
sudden effusion in the luugs, which had been w eakened by
a previous pulmonary complaint.
   I wish the friends of bark and wine in the yellow fever,
or of  moderate bleeding with antimonial medicines,  would
publish an account of the  number  of their  deaths by  the
fever, within' the  period I have  mentioned, and with the
same  fidelity  I have done.  The contrast  would for ever
decide  the controversy  in favour  of  copious depletion.
The mortality under die tonic  mode of practice may easily
be conceived  from die acknowledgment  of one  of the
gentlemen who used it, but who premised it, in many cases,
             • Mi.dical K.-says  and Observations, p. 28. 
232
AN  ACCOUNT OF THE
by two or three  bleedings. He informed Dr. Woodhouse,
that out of twenty-seven patients, whom he had attended in
the yellow fever, he had saved but nine. Other practitioners
were I believe, equally unsuccessful, in proportion to the
number of patients whom they attended.   The reader will
not admit of many deaths having occurred from the diseases
(formerly enumerated) to which they  were ascribed, when
he recollects that even a single death from most of them, in
common  seasons,  is a rare occurrence in the practice of
regular bred physicians.
  In  answer to  the account I have given of the mortality
of the fever of 1794, it  will be said,  that 30 persons died
less in that year, than in the healthy year of 1792.  To ac-
count for this,  it will  be necessary to recollect that  the
inhabitants of Philadelphia were reduced in number up-
wards of 4000, in the year 1793,  and of course that  the
proportion of deaths was greater in  1794 than it was in
1792, although the number was less.  It is remarkable that
the burials in the strangers' grave-yard  amounted in  the
year 1792 to but 20 i,  whereas in 1794 they were 676.
From this it appears, that the deaths must have been very
numerous among new comers (as they are sometimes called)
in the year 1794, compared with common years.  Now this
will easily be accounted for, when we recollect that these
people, who were  chiefly labourers, were exposed to the
constantly exciting causes of the  disease, and that, in all
countries, they are the principal sufferers by it.
   But in order  to  do justice to this comparative view of
the mortality induced by the yellow fever in the year 1794,
it will be necessary to examine the bill of mortality of the
succeeding year.   By this it appears that  2274  persons
died in 1795, making 1139 more than died in 1794.  The
greatness of this mortality, I well recollect, surprised many
of the citizens of Philadelphia, who had just passed an au-
tumn which was not unusually sickly, and who had forgotten
the uncommon mortality of the months of January, February,
and March, which succeeded the autumn of 1794.
   It  will probably  be asked, how it  came to pass that  I
attended  so  many more patients in this  fever than any of
my brethren.  To this I answer, that,  since the year 1793,
a great  proportion of my patients have consisted of stran-
gers,  and of the  poor; and as they are more exposed to the 
           BILIOUS YELLOW FEVER OF  1794.       233

 disease than other people, it follows,  that of the persons
 affected by the fever, a greater proportion must have fallen
 to my share as patients, than to other physicians. My abili-
 ty to attend a greater number of patients than most of my
 brethren,  was facilitated by my having at the time of the
 fever, several ingenuous and active pupils, who assisted me
 in visiting and prescribing for the sick.   These pupils were,
 Ashton Alexander and Nathaniel Potter (now physicians at
 Baltimore,) John Otto (now physician in Philadelphia,) and
 Gilbert Watson (since dead of the yellow fever.)
   The antiphlogistic remedies were not successful in Phi-
 ladelphia,  in the yellow fever,  in my hands alone.   They
 were equally,  and perhaps more so, in the  hands of my
 friends Dr. Griffitts, Dr. Physick,  Dr. Dewees, and Dr.
 Woodhouse.
   They were moreover successful at the same time in New-
 Haven, Baltimore, and  in Charleston,  in South-Carolina.
 Eighteen  out of twenty died of all who took bark and wine
 in New-Haven,  but only one  in ten of those who used the
 depleting medicines.  In a letter from Dr. Brown,  a phy-
 sician of eminence in Baltimore,  dated November 27th,
 1794, he  says, " of the many cases which fell to my care,
 two only proved mortal where I was called on the first day
 of the disease, and had an uncontrolled  opportunity to fol-
 low my judgment.  Where salivation took place, I had no
 case of mortality;  and in two of those cases a black vomit-
 ing occurred."  Dr. Ramsay, of Charleston,  in a letter  to
 one of his friends  in this city, dated October 14th, 1794,
 subscribes to the  efficacy of  the same practice  in a  fever
 which prevailed at that time in Charleston, and which, he
 says, resembled  the yellow fever of Philadelphia in the year
 1793.
  But the success of the depleting system was not confin-
ed to the United States.   In a letter before quoted,  which
I received from Dr. Davidson; of St. Vincents, dated July
22d, 1794, there is the following testimony in favour of
evacuations from the blood-vessels, bowels,  and salivary
glands :
  " Where the fever comes on with great determination to
the head,  and an affection of the stomach, in consequence
of that determination, violent head-ach, redness of the eyes,
turgescence of the face, impatience of light, &c. attended
   vol. iu.               c g 
234             AN ACCOUNT OF THE
 with a full and hard pulse, blood-letting should be employ-
 ed freely and repeatedly, cold applications should  be ap-
 plied to the head, and purging medicines should be em-
 ployed.  As a purge, calomel has been used with the great-
 est advantage,  sometimes by itself, but most frequently
 combined with  some active purgative medicine, such as
 jalap.  From some peculiarity  in the disease, an uncom-
 mon quantity of the calomel is necessary to affect the bow-
 els and salivary glands.   As I found a small quantity of it
 did not produce the effect I wished for promptly,  I have
 gradually increased the  quantity, until I now  venture to
 give ten grains of it, combined with five of jalap, every two
 hours until stools are procured.  The calomel is then eiven
 by itself.                                         &
   " The patients have generally an aversion to wine. The
 bark is seldom found of much advantage in this  state of the
 fever, and frequently brought on a return of the vomiting.
 I preferred to it,  in a remission of the symptoms, a vinous
 infusion of the quassia, which sat better upon the stomach."
   In the island of Jamaica, the depleting system has been
 divided.  It appears from  several publications in  the Kings-
 ton papers, that  Dr. Grant had adopted blood-letting, while
 most of the physicians of the island rest the cure of the yel-
 low fever upon strong mercurial purges.  The ill effects of
 moderate bleeding probably threw  the lancet into disrepute,
 for the balance of success, from those publications, is evi-
 dently  in  favour of simple purging.  I have no doubt of
 the truth of the above statement of the controversy between
 the exclusive advocates for bleeding and purging; or per-
 haps the superior efficacy  of the latter  remedy may be ex-
 plained in the following manner.
   In warm climates, the yellow fever is generally, as  it was
 in Philadelphia in the month of  August and in  the begin-
 ning of September,  1793, a disease of but two or  three
 paroxysms. It is sometimes,'I believe, only a simple  ephe-
 mera.   In these  cases, purging alone is sufficient to reduce
 the system, without the aid of bleeding.   It was found to
 be so until the beginning of September, in 1793, in most
 cases m Philadelphia.  The great prostration of the sys-
tem m the yellow fever,  in warm weather  and in hot cli-
mates, renders the restoration of it to a healthy state of ac-
tion more gradual, and of course  more safe,  by means of 
          BILIOUS YELLOW FEVER  OF 1794.        235

purging than bleeding. The latter remedy does harm, from
the system  being below the point of re-action,  after the
pressure  of the blood  is taken from it,  or  by restoring
the blood-vessels  too suddenly to  preternatural  action,
without reducing  them afterwards.   Had bleeding  been
practised agreeably  to  the method  described  by  Rive-
rius (mentioned in the  history of the fever of 1793), or
had the  fever in  Jamaica run on  to more than four or
five paroxysms, it  is probable the loss of  blood would have
been not only safe, but generally beneficial. I have, in the
same history, given my reasons why  moderate bleeding in
this, as well as many other diseases, does harm.  In those
cases where it has  occurred in large quantities from natural
haemorrhages, it has always done service in the West-
Indies.   The inefficacy, and,  in some cases,  the evils, of
moderate blood-letting are not confined to the yellow fever.
It is equally ineffectual, and,  in some  instances, equally
hurtful, in apoplexy, internal dropsy of the brain, pleurisy,
and  pulmonary  consumption.  Where all the different
states of  the pulse which indicate the  loss of blood are per-
fectly understood,  and blood-letting conformed in time and
in quantity to them,  it never can do harm, in any disease.
It is only  when it is prescribed empirically, without the
direction of just principles, that it has ever proved hurt-
ful.  Thus  the fertilizing vapours of heaven, when they
fall only in dew, or in profuse showers of rain, are either in-
sufficient to promote vegetation, or altogether destructive
to it.
   There may be habits in which great and long protracted
debility may have so far exhausted the active powers of the
system, as  to render bleeding altogether improper  in this
disease, in a West-India climate.   Such habits  are  some-
times produced  in soldiers and sailors, by the hardships of
a military and naval life.   Bleeding in such cases, Dr. Da-
vidson assures me in a letter,  dated from Martinique, Fe-
bruary 29th, 1796, did no good.  The  cure was effected,
under these circumstances,  by purges, and large doses of
calomel.   But where this chronic  debility does  not  occur,
bleeding, when properly used, can never be injurious, even
in a tropical climate, in the yellow fever.  Of this there
are many proofs in die writings of the most respectable
English and French physicians.  In spite of the fears and 
236             AN  ACCOUNT OF  THE
clamours  which  have been  lately  excited against  it  in
Jamaica, my late friend and contemporary at the college of
Edinburgh, Dr. Broadbelt, in a letter from Spanish Town,
dated January 6th, 1795, and my former pupil, Dr. Wes-
ton, in a letter from St. Ann's Bay, dated June 17th, 1795,
both assure me, that they have  used it in this fever  with
great success.  Dr. Weston  says that he  bled  " copiously
three  times in twenty-four hours, and thereby saved his
patient."
   The  superior advantages of the North American mode
of treating the  yellow fever,  by  means of all the common
antiphlogistic  remedies,  will appear  from comparing  its
success with that of the West-India physicians,  under all
the modes of practice which have  been adopted in the
islands.  Dr. Desportes lest  one half of all the patients he
attended in the yellow fever in one season in St. Domingo.*
His remedies were moderate bleeding and purging, and the
copious use of diluting drinks.  Dr. Bisset says,  " The
yellow fever is often under  particular circumstances  very
fatal,  carrying off four or five in seven  whom  it attacks,
and sometimes, but seldom,  it is so favourable as to  carry
off only one patient in five or six."f   The doctor does not
describe the practice under which this mortality takes place.
   Dr. Home, I have elsewhere  remarked, £ lost " one out
of four of his patients  in Jamaica."  His remedies  were
moderate bleeding and purging,  and  afterwards bark, wine,
and external applications of blankets  dipped in hot vinegar.
   Dr. Blane pronounces the yellow fever to be " one of the
most fatal diseases to which the human body is subject, and
in which human art is  the most unavailing."   His reme-
dies were bleeding,  bark,  blisters,  acid drinks,   saline
draughts and camomile tea.
   Dr. Chisholm acknowledges  that he lost one in twelve
of all the patients  he attended  in the fever  of Granada.
His  principal remedy was a salivation.  I shall hereafter
show the inferiority of this single mode of depleting, to a
combination of it with  bleeding and purging.  In Phila-
delphia and Baltimore,  where bleeding, purging, and sali-
vation were used in due time, and after the manner that has

   * Vol. i. p. 55.
   f Medical Essays and Observations, p. 29.
   k Account of the Yellow Fever of 179Z- 
BILIOUS YELLOW FEVER  OF 1794.       237
l;>een described,  not more than one  in  fifty  died of the
\ allow fever.   It is probable that greater certainty and suc-
cess in the treatment of this disease will not easily be attain-
ed, for idiosyncracy, and habits of intemperance which re-
sist or divert  the operation of the most proper remedies, a
dread of the lancet,  or the delay of an  hour in the use of it,
the partial application of that or any other remedy, the un-
expected recurrence' of a paroxysm of fever in the  middle
of the night, or the clandestine exhibition of wine or lauda-
num by friends or  neighbours, often defeat the best con-
certed plans of cure by a physician.   Heaven in this,  as in
other instances,  kindly limits  human power  and  benevo1
lence, that in all  situations man may remember dependence
upon the power and goodness of his Creator. 
 
•
      AN ACCOUNT





           OF





   SPORADIC CASES





           OF





BILIOUS YELLOW FEVER,





     IN PHILADELPHIA,




 TJV THE YEARS 1795 JW'D 1796.




                i 
 
AN ACCOUNT,  &c.
    IN my account of the yellow  fever, as it appeared in
 Philadelphia in the year 1794, I took notice of several cases
 of it which occurred in the spring  of the year 1795.   Be-
 fore I proceed to deliver the history of this  disease as it
 appeared in 1797,  I shall mention the diseases and state of
 the weather which occurred during the  remaining part of
 the year 1795, and  the  whole  of the year  1796.  This
 detail of facts, apparently uninteresting to the reader in the
 present state of our knowledge of epidemics, may possibly
 lead to principles at a future day.
  The month of April, 1795, was wet and cold. All the
 diseases of this month partook of the inflammatory charac-
 ter of the preceding winter and  autumn, except the mea-
 sles, which were unusually mild.
  The weather in May was alternately wet, cool, and warm.
 A few cases of malignant fever  occurred this month, but
 with moderate symptoms.  In June the  weather was  cool
 and pleasant.  The  measles put  on more inflammatory
 symptoms than in the preceding  months.  I had  two cases
 of mania under my care this month, and one of rheumatism,
 which  were attended with intermissions and exacerbations
 every other day.
  The  weather on the 19th, 20th, 21st, and 22d days of
 July was very warm, the mercury being at 90° in Fahren-
 heit's  thermometer.   The fevers of this month  were all
 accompanied with black discharges from the  bowels.  Mr.
 Kittera, one of the representatives of Pennsylvania  in the
 congress of the United States, in consequence of great fa-
 tigue on a warm day, was affected with the usual symptoms
 of the yellow  fever. During his illness he constantly com-
plained of more pain  in the left, than in the right side of
his head. His pulse was more tense in his left, than  in his
     VOL. III.            h h 
242     AN ACCOUNT OF SPORADIC CASES OF

right arm.  During  his convalescence, it was more quick
in the left arm, than it was in the right.  He was cured by
a  salivation and  the loss  of above 100 ounces of blood.
His head-ach was relieved  by the application of a bladder
half filled with ice to his forehead.
   Most of  the cases of bilious fever,  which came under
my notice, were attended with quotidian, tertian, or quartan
intermissions.  In a few of my patients there was a uni-
versal rash.
   Dr. Woodhouse informed me, that he had seen several
instances in which the yellow fever appeared in the same
place in which some soldiers had  laboured under the  dy-
sentery.  These  facts  show the  unity of fever, and the
impracticability  of a nosological arrangement of diseases.
   The cholera infantum was severe and fatal, in many in-
stances, during this  month.  It yielded to  blood-letting in
a child  of Mr. Conyngham, which was but four months
old.  In a child of seven wreeks old which came under my
care, I observed the coldness, chills, hot fits, and remissions
of the bilious fever to be as distinctly marked as ever I had
seen them in adult patients.  In a child of Mr. Darrach,
aged 5  months, the  discharges from the bowels were of a
black colour. I mention these facts in support of an opinion
I formerly published, that the cholera infantum is a bilious
fever, and that it rises and falls in  its  violence with the
bilious fever of grown persons.
  About the latter end of this month and the beginning of
August, there were heavy showers of rain, which carried
away fences, bridges, barns, mills, and dwelling-houses in
many places. Several cases of bilious yellow fever occur-
red in the month  of August.  In one of them it was accom-
panied with that morbid affection in  the wind-pipe which
has  been called  cvnanche trachealis.  It  was remarkable
tliat  sweating became a more  frequent symptom of the
fevers of this month  than it had been in July.  Hippocrates
ascribed this change in the  character of bilious fevers to
rainy weather.  Perhaps it was induced  by the rain which
fell in the beginning  of the month, in the fevers which have
been named.
  Among the persons affected  with the  yellow fever dur-
ing this month, was William  Bradford, Esq.  the attorney-
general of the United States.   From a dread of the lancet 
      BILIOUS YELLOW FEVER IN 1795 & 1796.   243

he objected to being bled in the early stage of his disease,
in consequence of which he died on the 23d of August,
in the  39th year of his age, amidst the tears of numerous
friends, and the lamentations of his  whole country.
   On the 30th and 31st of August, there was a fall of rain,
which suddenly checked the fever of the season, insomuch
that the succeeding autumnal  months were uncommonly
healthy.  Several showers of  rain  had  nearly the same
effect in  New-York,  where this fever carried off,  in a few
weeks, above 700 persons.  It prevailed, at the same time,
and with  great mortality, in the city of Norfolk,  in  Vir-
ginia.
   In both diose cities, as well as in Philadelphia, die disease
was evidently derived from putrid exhalation.
   In the same month, the dysentery prevailed in New-Haven,
in Connecticut, and in the same part of the town in which
the yellow fever had prevailed the year before.   The latter
disease was said to have been imported, but the prevalence
of the  dysentery,  under the above circumstances, proved
that both diseases were of domestic origin.
   The fever, as it appeared in Philadelphia, yielded in most
cases to  depleting remedies.   After  purging  and  blood-
letting, I gave bark, where the fever intermitted, with ad-
vantage.   It was effectual only when given in large doses.
In one instance,  it  induced  a spitting  of blood, which
obliged me to lay it aside.
   The winter of 1796 was uncommonly moderate. There
fell a good deal of rain, but little  snow.  The  navigation
of the Delaware was stopped but two or three days during
the whole season.   Catarrhs were  frequent, but very few
violent or acute  diseases occurred in my practice.   The
month  of March and the first week in April wrere  uncom-
monly dry. Several cases of  malignant bilious fever  came
under my care during diese months.  A little girl, of five
years old, whom I lost in this fever, became yellow in two
hours after her death.
   The measles prevailed in April, and were of a most in-
flammatory nature.   The weather in May and June was
uncommonly wet.   The fruit  was much injured, and  a
great deal of hay destroyed by it.   On the  14th of June,
General Stewart  died, with all the usual symptoms of a
fatal yellow fever.  Several other cases of it, in this and in 
 244     AN ACCOUNT OF SPORADIC CASES, &C.

 the succeeding month, proved mortal, but they excited no
 alarm  in  the city, as the  physicians who attended them
 called them by other names.
   The rain which fell about the middle of July  checked
 this  fever.  August,  September, and  October were un-
 usually healthy.   A  few cases  of malignant sore throat
 appeared in November.  They were, in all die patients that
 came under my  notice, attended with  bilious discharges
 from the stomach  and bowels.  So little rain fell during
 the  autumnal months,  that  the wheat  perished in many
 places.  The weather in December was  extremely  cold.
 The lamps of the city  were, in several instances, extin-
 guished by it, on the night of the  23d of the month, at
 which time the mercury stood at 2° below 0 in the thermo-
 meter.
   The yellow fever prevailed this  year  in Charleston, in
 South-Carolina,  where it was produced by putrid exhala-
tions from the  cellars  of houses which had been lately
burnt.   It  was said by the  physicians of that place not to
 be contagious.  The same fever prevailed,  at the same
 time, at Wilmington, in North-Carolina, and at Newbury -
 port, in the state of Massachusetts.   In the latter  place, it
 was produced by the  exhalation of putrid fish, which had
 been carelessly thrown upon a wharf.
END OF VOLUME III. 
MEDICAL  INQUIRIES

              AND


       OBSERVATIONS.
        BY BENJAMIN RUSH, M. D.

PAOFESSOR OF THE INSTITUTES AND FRACTICE OF MEDICINE AND OS
  CLINICAL PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA'




         FOUR VOLUMES IN TWO.


               VOL. IV.





            THE FIFTH EDITION.
      PHILADELPHIA:

PUBLISHED BY ANTHONY FINLEY,
  N. E. corner of Chesnut and Fourth-atreets
           181?, 
 
CONTENTS OF VOLUME IV.
                                                 Page
AN Account of the Bilious Remitting and Intermit-
  ting Yellow Fever, as it appeared in Philadelphia
  in 1797                                          3
An account of the Bilious  Yellow Fever, as it appear-
   ed in Philadelphia in the year 1798               39
An account of the Bilious Yellow Fever, as it appear-
   ed in Philadelphia in the year 1799               55
An account of  Sporadic Cases of Yellow Fever, as
   they appeared in Philadelphia in 1800            63
An account of  Sporadic  Cases of Yellow Fever, as
   they appeared in Philadelphia in 1801             69
An account of the Measles, as they appeared in Phi-
   ladelphia in 1801                                74
An account of the  Bilious Yellow  Fever,  as it ap-
  peared in Philadelphia  in the year 1802            77
An account of the Bilious  Yellow Fever, as it.appear-
   ed in Philadelphia in the year 1803               83
An account of  Sporadic  Cases of Yellow Fever, as
   they appeared in Philadelphia in 1804             91
An Account of the Bilious Yellow Fever,  as it ap-
  peared in Philadelphia  in the year 1805            95
An account of the Diseases  of 1806, 1807, 1308,
   and 1809                                       101 
                    CONTENTS.
                                                Pag*
An Inquiry into the various sources of the usual forms
  of Summer, and Autumnal Disease, in the United
   States, and the means of preventing them        107
Facts, intended to prove the  Yellow Fever not to be
   Contagious.                                   1^3
A Defence of Blood-Letting, as a remedy for certain
  Diseases                                      1'3
An Inquiry into the comparative state of medicine, in
   Philadelphia between the years  1760 and 1766,
   and the year 1809                             227 
          AN ACCOUNT





               OF THE





BILIOUS REMITTING AND INTERMITTING






        YELLOW FEVER,





               AS IT





      APPEARED IN PHILADELPHIA,





              IN 1797.
VOL. IV. 
 
AN ACCOUNT,  &c.
   THE winter of 1797 was in general healthy. During
the spring,  which was cold and wet, no diseases of any
consequence occurred.  The spring vegetables were late
in coming to maturity, and there were every where in the
neighbourhood of Philadelphia scanty crops of hay.  In
June and July there fell but little rain.  Dysenteries, cho-
leras, scarlatina, and mumps, appeared  in the suburbs in
the latter month.  On the  8th of July I visited Mr. Frisk,
and on the 25th of the same month I visited Mr Charles
Burrel  in the yellow fever, in consultation with Dr.  Phy-
sick.  They both  recovered by the use of plentiful deple-
ting1 remedies.
   The weather from the 2d to the 9th of August was rainy.
On the 1st  of this month  I was called to visit Mr. Natha-
niel Lewis, in a malignant bilious fever.   On  the  3d I
visited Mr. Elisha Hall, with  the same  disease.  He had
been ill several days before I saw  him.  Both  these gen-
tlemen died on the  6th of the month.  They were both
very yellow alter  death.   Mr. Hall had  a black vomiting
on the  day he died.
   The news of the death  of these two citizens, with un-
equivocal symptoms  of yellow fever, excited a general
alarm in the city.  Attempts were made  to trace it to im-
portation, but a little investigation soon proved that it was
derived from the foul air of a ship which had just arrived
from Marseilles, and which discharged her cargo at Pine-
stteet wharf, near  the stores occupied by Mr. Lewis and
Mr. Hall. Many other persons  about the same time  were
affected with the fever from the same cause, in Water and
Penn-streets. About the middle of the month, a ship  from
Hamburgh  communicated the  disease, by means of her
foul air, to the village of Kensington. It prevailed, more-
over, in many instances in the suburbs, and in Kensington,
from putrid exhalations from gutters and marshy grounds, 
4)              AN ACCOUNT OF THE

at a distance from the Delaware, and from the foul ships
which have  been mentioned.  Proofs  of  the truth  of
each of these assertions  were afterwards laid before the
public.
   The disease was confined chiefly to the district  of
Southwark and the village of Kensington,  for several
weeks. In September and October, many cases occurred
in the  city, but most of them were easily traced to the
above  sources.
   The following account of the weather, during the months
of August, September, and  October, was obtained  from
Mr. Thomas Pryor.  It  is  different from the weather in
1793.  It is of consequence to attend to this fact, inasmuch
as it shows that an inflammatory constitution of the atmos-
phere can exist under different circumstances of the wea-
ther.   It likewise accounts for the variety in the symptoms
of the fever in different years and countries.  Such is the
influence of season and climate upon the symptoms of this
fever, that it led Dr. M'Kitterick to suppose that the yellow
fever of Charleston, so accurately  described by Dr. Lin-
ing, in the second volume of the  Physical  and Literary
Essays of Edinburgh, was a different  disease  from the
yellow fever of the West-Indies.*

        * De Febre Indix-Occldentalis Maligna Flava, p. 12.
s 
BILIOUS YELLOW FEVER OF 1797.
0
METEOROLOGICAL OBSERVATIONS,
      MADE IN PHILADELPHIA.
AUGUST, 1797.
D. 1	Ther.		Bar.	Winds and Weather.
	73	75	30 0	S. E. E. Rain in the forenoon and afternoon.
2	72	76	30 0	N. E. by E. Cloudy, with rain in the afternoon and. night. Wind E. by N.
3	72	78	30 6	E. i N. Rain in the morning, and all day and night.
4	72	78	30 4	E. Rained hard all day and at night.
5	74	79	29 84	Wind light, S.W. Cloudy. Rain this morning. The air extremely damp; wind shitted to N. W. This evening heavy showers, with thunder.
6	73	76	30 86	W. N. W. Cloudy.
7	70	76	30 4	N. VV. Close day. Rain in the evening and all night. Wind to E.
8	72	76	29 95	E. Rain this morning.
9	72	76	29 86	S. W. Cloudy morning.
10	69	73	30 16	N. W. Clear.
11	70*	74	30 25	N. W. Clear. Rain all night.
12	71	74	30 5	S. W. Cloudy. Rain in the morning. Cloudy all day. Rain at night.
13	73	75	29 87	S. W. Cloudy. Rain all day.
14	70	74	29 9	N W. Clear fine morning.
15	36	60	30 15	N. W. Clear fine morning.
16	60	64	30 24	N. W. Clear fine morning.
17	60	65	30 24	N. W. Air damp.
18	68	75	30 4	S. W. Cloudy. Rain, with thunder at night: a fine shower.
19	72	78	29 7	N. W. Clear. Cloudy in the evening, with thunder.
2u	70	77	29 8	W N. W. Fine clear morning.
21	74	76	29 9	N.W. Clear to E.
22	68	76		E. Small shower this morning. Hard shower at 11, A.M. Wind N.E.
23	71	76	29 92	E. Cloudy. At noon calm.
24	71	75	29 95	Calm morning and clear.
25	70	75	30 5	N. E. Clear. Rain in the afternoon, with thunder.
26	70	T5	30 5	S. E. Rain in the morning. Rained hard in the night, with thunder, N.W.
27	68	76	29 9	N.W. Fine clear morning.
28	64	75	29 96	N.W. Clear.
29	59	70	30 0	E Clear.
30	70	76	30 1	E. by S. Rain in the morning.
i	68	74	30 14	S. E. Cloudy. Damp air and sultry.
 
(R           A|T ACCOUNT OF THE
SEPTEMBER, 1797.
D. 1	Ther.		liar.	Winds and Weather.
	73	80	36 6	S W. Cloudy. Damp air. Kain in the morning.
2	79	80	29 9	N. W. Clear. Cloudy in the evening, with light-
				ning to the southward.
3	68	74	30 0	N. by W. Cloudy. Clear in the afternoon and
				night.
4	60	74	30 7	W. N. W. Clear fine morning.
5	58	73	30 1	N. W Clear. Cloudy in the evening.
6	58	72	30 13	Fresh at E. Clear. Rain in the evening.
7	56	76	30 28	K. Clear. Cloudy in the evening.
8	54	66	30 1	N. E. Clear ind cool morning. Flying clouds at
:				noon. i
i 9	56	65	30 I	E. N. E. Clear.
10	58	63	30 26	N. E. Clear fine morning. Wind fresh at N. E. all
!				day.
11	53	64	30 13	N. to E. with flying clouds.
,12	5!	6J	30 6	W N. W. Clear cool morning.
I1-*	56	67	30 3	S. W Cloudy. Clear in the afternoon.
'14	64	70	29 98	S. W. Clear.
| IS	66	73	29 85	S. W. Rain in the morning. Cloudy in the after-
				noon.
16	62	70	29 95	N.W. Clear.
17	56	67	30 0	\. W. Clear.
;i8	5d	63	29 88 •29 :^2	E. Cloudy. Rained all day, and thunder. Rained very heavy at night.
19	55	63	29 75	W. N. W. Clear fine morning.
20	17	63	30 8	W. N. W Clear fine morning. New moon at 9 50
;				momitig-
21	46	60	30 0	N. E. Clear fine morning; to S. E. in the evening.
;				Cloudy at night.
122	56	65	30 4	N. W. Rain in the morning. Rain at night.
23	56	66	30 0	N. N. E. Cloudy.
24	52	66	29 9	E. by S. Clear fine morning. Cloudy at
			29 78	night.
25	57	68	29 37	W. N. W. Clear fine morning; clear all day.
26	58	68	29 95	E. [n the morning flying clouds.
27	48	63	30 2	tf ■ W. Clear fine morning; clear all day.
28	48	63	30 2	W. N. W. < lear fine morning; clear all day.
29	54	63	30 15	E. Clear fine morning.
30	6<	65	30 26	E. Fresh. Cloudy morning. Rain in the night.
 
HILIOUS VELLOW FEVER OF 1797.
OCTOBER, 1797.
D. 1	Ther. j Bar.			" ' --— Winds and Weather.
	55	65 30 16		N. E. Rain this morning, and great part of the day.
2	55	66	30 u	N.W. Clear.
3	60	70	29 9	S. E. Clear. Air damp.
4	60	70	29 5	W. N. W. Hain this morning.
5	46	60	30 0	W. \. W. to S. by W. in the evening. Clear all day. White frost this morning.
6	55	6s	30 0	S. W. Cleiir fine mornine. White frost
7	56	76	30 0 S. W. Cloudy. Rain in the night.	
8	56	70 30 29 JS. Cloud* ti s morinngi air damp. Wind shifted J to W N W. Blows fresh.		
9	50	60 30 85 W. N.W. Clear morning. Fresh at N. W. in the 1 1 evening.		
10	40	58	30 1 W. WW. Clear. Frost this morning.	
11	38	56	30 2 W-N.W. Cloudv.	
1? 34		52	30 38 W. N W. Clear. Ice this morning.	
13	35	55	30 5 N. Clear fine morning. Ice this morning.	
14	40	60	30 28 N. E. cloudy.	
15	50	65	30 16 W.N W. Clear.	
16	36	5fi	30 2 W. N. W Clear fine morning.	
17	37	56	30 18	W. N. W Clear fine morning.
18	47	60	JQ 86	W. N. W. Clear fine weather.
19 i 48		6(1	30 6	N. W. Clear fine day.
20| 42		55	30 8	N. E. Cloudy Rain in the afternoon and night
				Blows fresh* at N.E.
21	42	50	29 92	N. E. Blows fresh (with a little rain.) Thunder in the night, with rain.
22	44	56	29 57	N.W Rain in the morning.
23|44		56	29 95	S W. Clear fine morning.
24,42		54	30 5	N. E. Cloudy. A great deal of rain in the night.
2; 40		52	30 15	N. E. Clear fine morning.
26'36		48	30 29	W. N.W. Clear.
27134		46	30 23	Fresh at S.W. Clear.
'28 40		52	29 95	W. N. W. Cloudy.
29' 34		46	29 82	Vi\ Cloudy.
30:32,412			29 93	v.W. Clear. Hard frost this morning.
31 '38148			30 18	W. s. w. Cloudy part of this day; clear the re-
i 1				mainder. --------------------------------------^T----------■_■ -^A^J
 
8
AN ACCOUNT OF THE
    In addition to the register of the weather it may not be
  improper to add, that moschetoes were more numerous
  during the prevalence of the fever than in 1793.   An un-
  usual  number of  ants  and cock-roaches were  likewise
  observed:  and it was said that the martins and swallows
  disappeared, for a while, from the city and its neighbour-
 hood.
    A disease prevailed among  the cats some weeks before
 the yellow fever appeared in the city.  It excited a belief
 in an unwholesome state of the atmosphere, and apprehen-
 sions of a sickly fall.  It  generally proved fatal to them.
    After the first week in September there were no diseases
 to be seen but yellow fever. In that part of the town which
 is between Walnut and  Vine-streets it was uncommonly
 healthy.  A similar retreat of inferior diseases has been ob-
 served to take  place during the prevalence of the plague in
 London,  Holland, and Germany, according to the histo-
 ries of that disease by Sydenham, Diemerbroek,  Senner-
 tus, and Hildanus.  It appears, from  the register of the
 weather, that it rained during the greatest part of the day
 on the  1st of October.   The effects of this rain upon the
 disease shall be mentioned hereafter.  On the 10th  the
 weather became cool, and on the nights of the 12th and
 13th of the month  there was  a  frost  accompanied with
 ice, which appeared to give a sudden and complete check
 to the disease.
   The reader will probably expect an account of the effects
 of this distressing epidemic upon the public mind.  The
 terror of the citizens for a while  was very great. Rumours
 of an opposite and contradictory nature of the increase and
 mortality of the fever were in constant circulation. A stop-
 page was put to business, and it was computed that about
 two thirds of the inhabitants  left the city.
   The legislature of the state early passed a law, granting
 10,000  dollars for the relief of  the sufferers by the fever.
 The citizens in and out of town, as also many of the citi-
 zens of our sister states,  contributed more than that sum
 for the same charitable purpose. This money was issued
 by a committee appointed by the governor of the state.
 An hospital for the reception of the poor was established
 on the east side  of the river Schuylkill, and amply provided
with every thing necessary for the accommodation of the 
BILIOUS YELLOW FEVER OF 1797.        3
iick.   Tents were likewise pitched  on the east  side of
Schuylkill, to which  all those people were invited who
were exposed to the danger of taking the  disease,  and
who had not means to provide a more comfortable re-
treat for tnemselves in the country.
  I am sorry to add that the  mortal effects of the fever
upon the minds of our citizens were confined chiefly to
these acts of benevolence.  Many of the publications in
the  newspapers upon  its existence, mode  of cure,  and
origin, partook of a virulent spirit, which ill accorded
witn the distresses of the city. It was a cause of lamen-
tation likewise to many serious people, that the  citizens
in general were less disposed, than in 1793, to acknow-
ledge the agency of a divine hand  in their afflictions.   In
some a levity of mind appeared upon this solemn occa-
sion.   A worthy bookseller gave me a melancholy proof
of this assertion,  by informing me, that  lie  had never
been asked for. playing cards so often, in the same time,
as he had been during the prevalence of the fever.
  Philadelphia was not the only place in the United States
which  suffered by the yellow lever.   It prevailed, at the
same time,  at  Providence, in Rhode-Island, at Norfolk,
in Virginia, at Baltimore, and in many of the  country
towns of New-England, New-Jersey, and Pennsylvania.
  The influenza followed the yellow fever, as it did in
the  year 1793.  It made its appearance in the latter end
of October, and affected chiefly those citizens who had
been out of town.
  The predisposing causes of the yellow fever, in the
year 1797,  were the same as in the year 1793. Strangers
were as usual most subject to it.   The heat of the body
in such persons, in the West-Indies,  has  been found to
be between three and four degrees above that of the tem-
perature of the natives.  This fact is taken notice of by
Dr. M'Kitterick,  and to this he ascribes, in part, the pre-
disposition of  new comers to the yellow fever.
  In addition to the common exciting causes of this dis-
ease formerly enumerated, I have only to add, that it was
induced in one of  my patients by  smoking a segar.  He
had not been accustomed to the use of tobacco.
  I saw no new premonitory symptoms of this fever, ex-
cept a tooth*ach.  It occurred in Dr. Physick, Dr. Cald«
   VOL.  IV.               B 
10             AN ACCOUNT OF THE
well,  and in my pupil, Mr. Bellenger.   In Miss EHiot
there  was such a soreness in her teeth, that she could
hardly close her mouth on  the day  in which she was at-
tacked by the fever. Neither of  these persons had taken
mercury to obviate the disease.
   I shall now deliver a short account of the symptoms
of the yellow fever, as they  appeared in several of the
different systems of the body.
   I. There  was but little difference in the state of the
pulse in this epidemic from what has been recorded in
the fevers of 1793  and  17 4.   1 perceived  a pulse, in
several  cases, which felt like a soft  quill which had been
shattered by being trodden  upon.   It occurred in Dr.
Jones and Dr. Dobtli, and in several other persons who
had been worn down by great fatigue, and it was, in eve-
ry  instance,  followed by a fatal issue of the  fevtr.   In
Dr. Jones this state of the  pulse was accompanied with
such a difficulty of  breathing, that every breath he drew,
on the day of his attack,  he informed me, was the ef-
fort of a sigh.  He died on the  17th of September, and
on the sixth day of his fevtr.
   The action of the arteries was, as usual, very irregular
in many cases. In some there was a  distressing throbbing
of the vessels in the brain, and  in one of my patients  a
similar  sensation in the  bowels, but without pain. Many
people had issues of blood from their blisters in this fever.
   I saw nothing new in the effects of the fever upon the
liver, lungs, brain, nor upon the stomach and bow els.
   II. The excretions were distinguished by no unusual
marks,   I met with no recoveries where there were not
black stools.  They excoriated  the rectum in Dr. Way,
It was a happy circumstance where morbid bilious mat-
ter came away in the beginning of the disease.  But it
frequently resisted the most powerful  cathartics until the
5th or 7th day of the fever,  at  which time  it appeared
rather to yieid to the ciisorganizaticn of the liver than to
medicine.   Where sufficient blood-letting had been pre-
viously  used, the patient frequently recovered, even after
the black discharges from the bowels took place in a late
stage of the disease.
   Dr. Coxe informed me that he attended a child of se-
venteen  months old  which had white stools for several 
BILIOUS YELLOW PEVER OF  1797.       II
days.  Towards  the close of its disease it had black
stools, and soon afterwards died.
  Several of my patients discharged worms during the fe-
yer. In one instance they were discharged from the mouth.
  A preternatural frequency in making pale water attend-
ed the first attack of the disease in Mr. Joseph Fisher.
  A discharge of an unusual quantity of urine preceded
a few hours, the death of the daughter of Mrs. Read.
  In two of  my patients there was a total suppression of
urine.   In one of them it continued five days without
exciting any pain.
  There was no  disposition to sweat after the first and
second days of the fever.   Even  in those states of the
fever, in which  the intermissions were  most complete,
there was seldom any  moisture, or  even softness on the
skin.  This was so characteristic of malignity in the bili-
ous fever, that where I found the opposite state of the
skin,  towards the close of a paroxysm,  I did not hesitate
to encourage my patient, byassuring him that his fever
was of a mild nature,  and would most  probably  be safe
in its  issue.
  III. I saw no unusual marks of the disease in the ner-
vous system. The mind was seldom affected  by dilirium
after the loss of blood.  There was a disposition to shed
tears in two of my patients.   One of them wept  during
the whole time of a paroxysm of the fever.   In one case
I observed an uncommon dullness of apprehension,  with
no other mark of a diseased state of the mind.   It was
in a man whose faculties, in ordinary health,  acted with
celerity and vigour.
  Dr. Caldwell informed me of a singular change which
took place in the operations of his mind  during his reco-
very from the fever.   His imagination carried him back
to an early period of his life, and engaged him, for a day
or two, in playing with a bow and arrow, and in amuse-
ments of which he had been fond of when a boy.  A  si-
milar change occurred in the mind  of my former pupil,
Dr. Fisher, during  his  convalescence  from the yellow
fever in  1793.   He amused himself for two days in look-
ing over the pictures  of a family bible which lay in his
room, and declared that he found the same kind of plea-
sure in this employment that he did when a child. How, 
 12             AT ACCOUNT OF THE

 ever uninteresting these facts  may now appear, the time
 will come when they may probably furnish useful hints for
 completing the physiology and pathology of the mind.
   Where blood-letting had  not been  used, patients fre-
quently died of convulsions.
   IV. The senses of seeing and feeling were impaired in
 several cases.   Mrs. Bradford's vision was so weak that
 she hardly knew her friends at  her bed-side.   I had great
 pleasure in observing this alarming symptom,  suddenly
 yield to the loss of four ounces of blood.
   Several persons who  died of ihis fever did  not, from
the beginning to the end of  the disease, feel any pain.  I
 shall hereafter endeavour to explain the cause of this in-
sensible state of  the nerves.
   The appetite for food was unimpaired for three days in
 Mr. Andrew Brown, at a time when his pulse indicated
a high grade of  the fever.   I  heard of several persons
who ate with avidity just before they died.
   V. Glandular swellings »were very uncommon in this
fever.   1  should have ascribed their absence to the copi-
 ous use of depleting remedies in my practice, had 1 not
 been  informed that morbid  affections of the  lymphatic
 glands were unknown in the city  hospiial, where blood-
letting was seldom used, and where the patients, in many
instances,  died before they had time to take medicine of
any kind.
   VI. The skin was cool, dry, smooth, and even shining
in some cases.  Yellowness was  not universal.  Those small
red spots which has been compared to moscheto bites oc-
curred in  several of my patients. Dr. John Duffield, who
acted as house surgeon" and  apothecary at the city hospi-
tal, informed n e that he saw vibices on the  skin in many
cases, and that  they were ail rr o e or less sore to the touch.
   VII.  The blood was dissolved  in a few cases.  That
appearance of  the blood, which has been compared to the
washings  of flesh, was very common.  It  was more or
less sizy towards the close  of  the disease in most  cases.
I have suspected, from this circumstance, that  this mark
of ordinary morbid  action or  inflammation was in part
the effect  of the mercury acting upon the blood-vessels.
It is well  known that sizy blood generally accompanies a
salivation.  If this conjecture be well founded, it will not 
          BILIOUS YELLOW FEVER OF 1797.        13

militate against the use of mercury in  malignant fevers,
for it shows that this valuable medicine possts*es a pow-
er of changing an extraordinary  and  dangerous degree
of morbid action in the  blood-vessels to  that which is
more common and safe.   I have  seldom seen a yellow
fever terminate fatally after the appearance of sizy blood.
  Dr.  Stewart informed me, that in those cases in which
the strum of the blood had a yellow colour, it imparted a
saline taste only to his tongue.  He was the more si ruck
with this fact, as he perceived a strong bitter taste upon
his skin, in a severe attack of the yellow fever in 1793.
  I proceed next to take notice of the type of the fiver.
  In many cases, it  appeared in the form of a re milting
and inttrmittinjr fever.  The quotidian and tertian forms
were most common.   In Mr. Robert Warton, it appear-
ed in the form of a quartian.   But it frequently assumed
the character which is given of the same fe\er in Char-
leston, by  Dr. Lining   It came on without chills,  and
continued  without any remission for three days, after
which  the patient believed himself to be well, and some-
times rose from his  bed,  and applied  to business.   On
the fourth or fifth day, the fever returned, and unless co-
pious evacuations had been used in the early stage of the
disease, it generally proved fatal.   Sometimes the powers
of the  system were depressed below the return of active
fever, and the patient sunk away by an easy de^th, without
pain, heat, or a quick pulse.  I have been much puzzled
to distinguish a crisis of the fever on the third or fourth
day, from the insidious  appearance  which has been  de-
scribed.   It deceived me in 1793.   It may be  known
by a preternatural coolness in the skin, and languor in
the pulse, by an inability to sit up long without fatigue
or faintness, by a dull  eye, and by great depression of
mind,  or such a flow  of spirits as sometimes to produce
a declaration from the patient that " he feels too well."
Where these symptoms appear, the patient should be in-
formed of his danger, and urged  to the continuance of
such remedies  as are proper for him.
  The following states or forms  were  observable in the
fever:
   I. In a few cases, the t  iasmata produced death in four
and  twenty  hours, with convulsions, coma, or apoplexv. 
14
AN  ACCOUNT OF THE
  2. There were open cases, in which the pulse was full
and tense as in a pleurisyr or rheumatism, from the begin-
ning to the end of the fever.  They were  generally at-
tended with a good deal of  pain.
  3. There were depressed or  locked  cases, in which
there were a season of great debility, but little or no pain,
a depressed and slow pulse,  a cool skin, cold hands and
feet, and obstructed excretions.
  4. There were divided or  mixed cases,  in which the
pulse was active until the 4th day, after which it became
depressed. All the other symptoms of the locked state of
the fever accompanied this depressed state of the pulse.
  5. There were cases in  which the pulse imparted a
perception like that of a soft and shattered quill.  I have
before mentioned that this state of the pulse occurred in
Dr. Jones and Dr. Dobell.   I felt it but once, and on the
day of his attack, in the latter gentleman, and expressed
my opinion of his extreme  danger to one  of my pupils
upon  my return from visiting him   I did not meet with
a case which  terminated favourably,  where I perceived
this shattered pulse.   A disposition to sweat occurred in
this state of the fever.
  6 There were what Dr. Caldwell happily called walk-
ing cases.  The patients here were flushed  or pale, had
a full or tense pulse, but complained of no pain,  had a
crood appetite, and walked about their room or houses, as
if they were but little indisposed, until a  day or two,
and, in some  instances, until a  few hours  before they
died.  We speak of a dumb  gout and dumb rheumatism;
with equal propriety, the epithet might  be applied to this
form of yellow fever in its early  stage.  The impression
of the remote cause of the fever, in these cases, was be-
yond  sensation, for, upon removing a part of it by bleed-
ing or purging, the  patients complained of pain, and the
excitement of the muscles passed so  completely into the
blood-vessels and alimentary canal, as to convert the fe-
ver into  a common and more natural form.   These cases
were always dangerous, and, when neglected, generally
terminated in  death. Mr. Brown's fever came on in this
insidious shape.  It was cured by the loss of upwards of
100 ounces of blood, and a plentiful salivation. 
BILIOUS YELLOW FEVER OF 1797.        15
  7. There was  the intermitting form  in this fever.
This, like the last, often deceived the patient, by leading
him to suppose his disease was of a common or trifling
nature.   It prevented Mr. Richard Smith from applying
for medical aid in an attack of the fever for several days,
by which means it made such an  impression upon his
viscera, that depleting remedies  were in vain used  to
cure him.   He died in the prime of life, beloved and la-
mented by a numerous circle of relations and friends.
  8. There was a form of this fever in which  it resem-
bled the mild remittent of  common seasons.  It was dis-
tinguished from it chiefly  by the black colour of the in-
testinal evacuations.
  9. There were cases of this fever  so light, that pa-
tients were said to be neither sick nor well; or, in other
words, they were sick and well half a dozen times in a
day.  Such persons walked about, and transacted  their
ordinary business, but complained of dulness, and, occa-
sionally, of shooting pains in their  heads.  Sometimes
the stomach was  affected  with sickness,  and the bowels
with diarrhoea or costiveness.  All of them complained of
night sweats.   The pulse was quicker than natural, but
seldom had that convulsive action  which constitutes fe-
ver.  Purges always brought away black stools from such
patients, and this circumstance served to establish its re-
lationship to the prevailing epidemic.   Now and then, by
neglect or improper treatment,  it assumed  a higher and
more dangerous grade of the fever, and became  fatal,
but it more commonly  yielded to nature,  or to a single
dose of purging physic.
   10.  There were a few cases in which the skin was af-
fected with universal yellowness, but without more pain
or indisposition than usually occurs in the jaundice. They
were very  frequent in the year 1793, and generally pre-
vailed in the autumn, in all places subject to bilious fever.
   12.  There were chronic cases of this fever.   It is from
the want of observation that physicians limit the duration
of the yellow fever to certain days.   I have seen many
instances in which it has been protracted  into what is cal-
led by authors a slow nervous fever.   The wife of cap-
tain Peter Bell died with a black vomiting after an illness
©f nearly one  month.  Dr. Pinckard, formerly  one  of 
61
AN ACCOUNT OF THE
 the physicians of the British army in the West-Indies,
 in a late visL  to this city informed me, that he had often
 seen the yellow fever put on a chronic form in the West-
 India islands.
   In. delivering this detail of the various forms of the yel-
 low fever, I am aware that I oppose the opinions of many
 of :nv medical brethren, who ascribe to it a certain uniform
 character, which is removed beyond the influence of cli-
 mate, habit, predisposition,  and the different strength and
 combinations  of remote and exciting causes.   This uni-
 formity in the  symptoms oi this lever is said to exist in the
 West Indies,  and  every deviation from it  in  the United
 States  is  called by another name.  The  following com-
 munication, which I received from Dr. Pinckard, will
 show that this disease is as  different  in its forms in the
 West Indies as it is in this  country.
  " The yellow fever,  as it appeared among  the troops
 in Guiana and the West India islands, in the year 1796
 and 1797, exhibited such perpetual instability, and varied
 so incessantly  in its character, that I  could not  discover
 any one symptom  to be decidedly diagnostic; and hence
 I have  been led into an opinion that  the yellow fever, so
 called,  is not a distinct or specific disease,  but merely  an
aggravated degree of the common remittent or bilious fe-
ver of hot climates, rendered irregular in form, and aug-
 mented in malig .itv, from appearing in subjects unaccus-
tomed  to  the climate.
  "Philadelphia, January \2th, 1798."

  Many other authorities  equally respectable with Dr.
Pinckard's, among whom are Pringle, Huck, and Hunter,
might be  adduced in support of the unity oi  bilious fever.
But to multiply them further would be an act of homage
to the  weakness of human reason, and an acknowledg-
 ment of the  infant state of our knowledge in  medicine.
As well might  we suppose nature to be an artist,  and that
diseases we»*e shaped by her like a piece of statuary or a
suit of clothes, by  means of a chisel,  or pair of scissars,
as admit every different form and  grade of morbid action
in the system to be a distinct disease.
  Notwithstanding the fever put on the eleven forms which
have been described, the moderate cases were few, com- 
BILIOUS YELLOW FEVER OF 1797.       17
 pared with those of a malignant  and dangerous nature.
 It was upon this account that the mortality was greater
 in  the same number of patients, who were treated with
 the same remedies, than it was in  the years  1793  and
 1794.  The disease, moreover, partook of a more  ma-
 lignant character than the two epidemics that have been
 mentioned.  The  yellow fever in Norfolk, Drs. Taylor
 and Hansford informed me, in a  letter I  received from
 them, was much more malignant and fatal, under equal
 circumstances, than it was in 1795.
   There were evident marks  of the disease attacking
 more persons three days before, and three days after the
full and change of the moon, and of more deaths occur-
 ring at those periods than at any  other time.  The same
 thing has been remarked in the plague by Diemerbroeck,
 in the fevers of Bengal by Dr. Balfour, and in those of
 Demarara by Dr. Pinckard.
   During the prevalence of the fever I attended the fol-
 lowing persons who had been affected by  the epidemic
 of 1793, viz. Dr. Physick, Thomas Learning, Thomas
 Canby, Samuel Bradford, and George Loxley, also Mrs.
 Eggar, who had a violent attack  of it in the year 1794.
 Samuel Bradford was likewise affected by it in 1794.
   During my intercourse with the sick, I felt the mias-
 mata  of the fever operate upon  my system in the most
 sensible manner. It produced languor, a pain in my head,
 and sickness at my stomach.   A sighing attended me
 occasionally, for upwards of two weeks.   This symptom
 left me suddenly, and was succeeded by a hoarseness,
 and, at times, with such a feebleness in my voice as to
 make speaking painful to me.   Having observed this af-
 fection of the trachea to be a precursor of the fever in
 several cases, it kept me  under  daily  apprehensions of
 being confined by it. It gradually went off after the  first
 of October.  I ascribed my recovery from it, and a sud-
 den diminution of the effects of the miasmata upon my
 system, to a change produced in the atmosphere by the
 rain which fell on that day.
   The peculiar matter emitted by the breath or perspira-
 tion of persons affected by this fever, induced a sneezing
 in Dr. Dobell, every  time he  went into  a sick  room.
   VOL. IV.                 C 
13
AN  ACCOUNT OF THE
Ambrose Parey says the same  thing  occurred to him,
upon entering the room of patients confined by the plague.
  The gutters emitted, in  many places, a sulphureous
smell during the prevalence of the fever.   Upon rubbing
my hands together I could at any time excite a similar
smell in them.  I have taken notice of this effect of the
matters which produced the disease upon  the body, in
the year 1794.
  In order to prevent an attack of the fever,  I carefully
avoided all its exciting causes." I reduced my diet, and
lived  sparingly upon tea, coffee, milk, and the common
fruits and garden vegetables of the season, with a small
quantity of salted meat, and smoked herring.  My drinks
were milk and water, weak claret and water,  and weak
porter and water. I sheltered myself as much  as possible
from the rays cf the sun, and from the action of the even-
ing air, and accommodated my dress, to  the changes in
the temperature of  the atmosphere.  By  similar means,
I have reason to believe, many  hundred people escaped
the disease, who were constantly exposed to it.
   The number of deaths by the fever, in the  months of
August, September, and October,  amounted  to between
ten and eleven hundred.  In the list of the dead were nine
practitioners of physic, several of whom were gentlemen
of the most respectable characters.  This number will
be thought considerable when  it is added, that not  more
than three or four and twenty physicians attended patients
in the disease.   Of the survivors of  that number,  eight
were affected with the fever.   This  extraordinary  mor-
tality and sickness among the physicians must be ascribed
to their uncommon fatigue, in  attending  upon the  sick)
and to their inability to command their time and labours,
so as to avoid the exciting causes  of the fever.
   Among the medical gentlemen whose deaths have been
mentioned, was my excellent friend,  Dr. Nicholas Way.
I shall carry to my grave an affectionate remembrance of
him. We passed our youth together in the study of me-
dicine, and lived  to the time of his death in the habits of
the tenderest friendship.  In the year 1794, he removed
from Wilmington, in the Delaware state, to Philadelphia,
where his talents and manners soon introduced him into
extensive business.  His independent fortune furnished his 
BILIOUS YELLOW FEVER OF 1797.       19
friends with arguments to advise him to  retire  from the
city, upon the first appearance of  tiie fever,  ini his .iu*
manity prevailed over the dictates of inteivst and heiovc
of life.   He was active and intelligent in suggesting and
executing plans to arrest the progress of the disease, and
to lessen the distresses of the poor. On the 27th of August^
he was seized, after a ride from the country in the evening
air, with a chilly fit and fever.  I saw him the next day, and
advised the usual depleting remedies. He submitted to my
prescriptions with reluctance, and in a sparing manner,
from an opinion that his fever was nothing but a common
remittent. To enforce obedience  to my advice, I called
upon Dr. Griffitts to visit him with me.  Our combined
exertions to overcome his prejudices against our remedies
were ineffectual.   At two o'clock in the afternoon, on the
sixth day of his disease, with an aching heart I saw the
sweat of  death upon his forehead, and felt his  cold  arm
without a pulse.   He spoke to me with difficulty:  upoa
rising from his bed-side to  leave him, his eyes filled with
tears,  and his countenance spoke a language which  I am
unable to describe.  I promised to return in a short time,
with a view of attending the last scene of his life. Imme-
diately after I left his room, he wept aloud.  I returned
hastily to him, and found him in convulsions.  He died a
few hours afterwards.   Had I met with no other afflic-
tion in the autumn of 1797  than  that which  I experi-
enced from this affecting scene, it would  have been  a se-
vere one; but it was a part only of what i suffered from the
death of other friends, and from the malice of enemies.
  I beg the reader's pardon for this digression.  It  shall
be the last time and place  in  which any  notice shall be
taken of my sorrows and persecutions in the  course of
these volumes.
  Soon after the citizens returned from the country, the
governor of the state, Mr. Mifflin, addressed a letter to the
college of physicians of Philadelphia, requesting to know
the origin, progress, and nature of the fever which  had
recently afflicted the city, and the means of preventing its
return.   He addressed a similar letter to me, to be com-
municated to such gentlemen of the faculty of  medicine
as were not members of the college of physicians.
  The college, in a memorial to the legislature of the state. 
&>
AN ACCOUNT OF THE
asserted that the fever had been imported in two  ships,
the one from Havannah, the other from Port au Prince,
and recommended, as the most effectual means of  pre-
venting its recurrence, a more rigid quarantine law.
   The gentlemen of the faculty of medicine, thirteen in
number,  in two letters to the governor of  the  state,  the
one in their private capacity, and the other after they had
associated themselves into an "Academy of Medicine,"
asserted that the fever had originated from the putrid exha-
lations from the gutters and streets of the city, and from
ponds and marshy grounds in its neighbourhood;  also
from  the foul air of two ships, the one from Marseilles
and the other from Hamburgh.  They enumerated all the
common sources of malignant fevers, and recommended
the removal of them from  the city, as the most effectual
method of preventing  the  return  of the  fever.  These
sources of fever,  and  the  various means  of destroying
them, shall be mentioned in another place.
   I proceed now to say a few words upon the treatment
which was used in this fever.  It was, in general, the same
as that which was pursued in the fevers of 1793 and 1794.
   I began the cure, in most cases, by bleeding, when I was
called on the first day of the disease, and was happy in
observing its usual salutary effects in its early stage. On
the second day, it frequently failed of doing service, and
on the subsequent days of the fever, I believe, it often did
harm; more especially if no other depleting remedy had
preceded it.  The violent action of the blood-vessels in
this disease, when left to itself for  two or three days, fills
and suffocates the viscera with such an immense mass of
blood, as to leave a quantity in the vessels so  small, as
barely to keep up the actions of life. By abstracting but
a  few ounces of this  circulating  blood, we precipitate
death. In those cases where a doubt is entertained of such
an engorgement of stagnating blood having taken place, it
will always be safest to take but three or four ounces at a
time, and repeat it four or  five times a day. By this mode
of bleeding, we give the viscera an opportunity of empty-.
ing their superfluous blood into the vessels, and thereby
prevent their collapsing, from the  sudden abstraction of
the stimulus which remained in them.  I confine this ob-
servation upon bleeding, after the first stage of the disease, 
          BILIOUS YELLOW FEVER OF  1797.        21

only to the epidemic of 1797. It was frequently effectual
when used for the first time after the first and second days,
in the fevers of 1793 and 1794, and it is often  useful in
the advanced stage of the common bilious  fever.  The
different  and contradictory accounts  of the effects of
bleeding in the yellow fever, in the West- Indies, probably
originate in its being used in different stages of the disease.
Dr. Jackson, of the British army, in his late visit to Phi-
ladelphia, informed  me, that he had cured nineteen out
of twenty of all the soldiers whom he attended, by copi-
ous bleeding, provided it was performed in six hours after
the attack of the fever.  Beyond that period, it mitigated
its force, but seldom cured. The quantity of blood drawn
by the doctor, in  this early stage of the disease,  was al-
ways from twenty to thirty ounces.  I have said the yel-
low fever of 1797 was more malignant than the fevers of
1793 and 1794.   Its resemblance to the yellow fever in
the West-Indies,  in not yielding to  bleeding after the first
day, is a proof of this assertion.
  I was struck, during my attendance upon this fever, in
observing the analogy between its mixed form and the ma-
lignant state of the small-pox.  The fever, in both, con-
tinues for three or four days without any remission.  They
both have a second stage, in  which death usually takes
place, if the diseases be left to themselves.  By means of
copious bleeding in their first, they  are generally deprived
of their malignity  and mortality in their second stage. This
remark, so trite in the small.pox, has been less attended
to in the yellow fever.   The bleeding in the first stage
of this disease does not, it is true,  destroy it altogether,
any more than it  destroys an eruption in the second stage
of the small-pox, but it weakens it in such a manner that
the patient passes through its second stage without pain
or danger, and with no other aid from medicine than what
is commonly derived from good  nursing, proper aliment,
and a little gently opening physic.
   It is common  with those practitioners who  object to
bleeding in the yellow fever, to admit  it occasionally in
robust habits.  This rule leads to great error in practice.
From the weak action of predisposing, or exciting causes,
the disease often  exists in a feeble  state  in such  habits,
while from the protracted or violent operation of the same 
22
AN  ACCOUNT OF THE
causes it appears in great force in persons of delicate conr
stitutions.  A physician, therefore, in prescribing for a
patient in this fever, should forget the natural strength of
his muscles, and accommodate the loss of blood  wholly
to the morbid strength of his disease.
   The quantity of blood drawn in this fever was always
proportioned  to its violence.  1 cured many by a single
bleeding.   A few required the loss of upwards of a hun-
dred ounces of blood to cure them.   The persons from
whom that large quantity of blood was taken, were, Mes-
sieurs Andrew Brown, Horace Hall, George Cummins,
J. Hamsay, and George Eyre. But I  was not singular in
the liberal and frequent use of the lancet.  The following
physicians drew the quantities of blood annexed to their
respective names from the following persons, viz.
   Dr. Devvees   176 ounces from Dr. Physick,
   Dr. Griffins   110            M. S. Thomson,
   Dr. Stewart   106            Mrs. M'Phail,
   Dr. Cooper   150            Mr. David Evans,
   Dr. Gillespie  103            himself.
   All the above named persons had a rapid and easy re.
covery,  and now enjoy good health.   I lost but one pa-
tient who had been the subject of early and copious bleed-
ing.  His death was evidently induced by  a  supper of
beef stakes and porter, after  he  had  exhibited the most
promising signs of convalescence.
                  OF PURGING.

  From the great difficulty that was found in discharging
bile from the bowels, by the common modes of adminis-
tering purges, Dr.  Griffitts suggested to me the propriety
of giving large doses  of calomel, without jalap  or any
other purging medicine, in order to loosen the bile from
its close connection with the gall-bladder and duodenum,
during the  first day of the disease.  This method of dis-
charging acrid bile  was found useful. I observed the same
relief from large evacuations of foetid bile, in the epidemic 
BILIOUS YELLOW FEVER OF  1797.      13
©f 1797, that I have remarked in the fever of 1793.  Mr.
Bryce has taken notice of the same salutary effects from
similar evacuations, in the yellow fever, on board the Bus-
bridge Indiaman, in the year 1792.   His words are: *« It
was observable, that the more dark-coloured and  foetid
such  discharges were, the more earl} and certainly did
the symptoms disappear.  Their good effects were so in-
stantaneous, that I have often seen a man carried up on
deck, perfectly delirious with subsultus tendinum, and in
a state of the greatest apparent debility, who, after one or
two copious evacuations  of this kind,  has returned  of
himself, and astonished at his newly acquired strength."*
Very different are the effects of tonic remedies, when given
to remove this apparent debilityr.  The clown who sup-
poses the crooked appearance of a stick, when thrust into
a pail of water, to be real, does  not err more against the
laws of light, than that physician errs against a law of the
animal economy, who mistakes  the debility which arises
from oppression  for an exhausted state of the system,
and attempts to remove it by stimulating medicines.
   After unlocking the bowels by means of calomel and
jalap, in the beginning of the fever,  I found no difficulty
afterwards in keeping them gently open by more lenient
 purges.  In addition to these which  I have mentioned in
 the account of the fever of 1793, I yielded to the advice
 of Dr. Griffitts,  by adopting the soluble tartar, and gave
 small doses  of it daily in many cases.  It seldom offend-
 ed the stomach, and generally operated, without griping,
 in the most plentiful manner.
   However powerful  bleeding and purging were in the
 cure of this fever, they often required the aid of a sali-
 vation to assist them in subduing it.
   Besides the usual methods of introducing mercury into
 the system, Dr. Stewart accelerated its action, by oblig-
 ing his patients to wear socks filled  with mercurial oint-
 ment; and  Dr. Gillespie aimed  at the same thing, by in-
 jecting  the ointment, in a suitable vehicle, into the bow-
 els, in the form of glysters.
   The following fact, communicated to me by Dr. Stew-
 art,  will show the safety of large  doses  of  calomel in
 this fever.   Mrs. M'Phail took 60 grains of calomel, by
                  • Annals of Medicin*, p. 123. 
24
AN  ACCOUNT OF THE
mistake, at a dose, after having taken three or four doses,
of 20 grains each, on the same day. She took in all, 356
grains in six days, and yet, says the doctor, " such was
the state of her stomach and  intestines, that  that large
quantity was retained without producing the least griping,
or more stools than she had when she took three grains
every two hours."
   I observed the mercury to  affect the mouth and throat
in the following ways.  1.  It sometimes produced a swel-
ling only in the throat, resembling a common inflammatory
angina.  2. It  sometimes produced ulcers upon the lips,
cheeks, and tongue, without any discharge from the sali-
vary glands. 3. It sometimes produced swellings and ulcers
in the gums, and loosened the teeth, without inducing a
salivation. 4. There were instances in which the mercury
induced a rigidity in the masseter muscles of the jaw, by
which means the mouth was kept constantly open, or so
much closed, as to render it difficult for the patient to take
food, and impossible for him  to masticate it. 5. It some-
times affected the salivary glands only,  producing from
them a copious secretion and excretion of saliva. But, 6.
It more frequently acted upon all the above parts, and it
was then it produced most speedily its salutary effects.
7. The discharge of the saliva frequently took place only
during  the remission or intermission of  the fever, and
ceased with each return of its paroxysms.  8. The saliva-
tion did not take place, in some cases, until the solution of
the fever. This was more especially the case in those forms
of the fever in which there was no remissions or intermis-
sions.   9. It ceased in most cases with  the fever, but it
sometimes  continued for six  weeks or two months after
the complete recovery of the  patient.   10. The mercury
rarely dislodged the teeth.  Not a single instance occurred
oi a patient losing a tooth  in the city hospital, where the
physicians, Dr. J. Dufneld informed me, relied chiefly upon
a salivation for the cure of the fever. 11.  Sometimes the
mercury produced a discharge of blood with the  saliva.
Dr. Coulter, of Baltimore, gave me an account, in a letter
dated the 17th  of September, 1797, of a boy in whom a
haemorrhage from the salivary glands, excited by calomel,
was succeeded  by a plentiful  flow of saliva, which saved
his patient.  I saw no inconvenience from  the mixture of
blood with saliva in any of my patients.   It occurred in 
BILIOUS YELLOW FEVER OF  1797.
25
Dr.  Caldwell,  Mr. Bradford,  Mr. Brown, and  several
others.
   It has been said that mercury does no  service unless
it purges or salivates.  I  am disposed to  believe that it
may act  as a counter stimulus to that of the miasmata of
the yellow fever,  and thus be  useful without producing
any evacuation  from the bowels or mouth.   It more cer-
tainly acts  in this way, provided blood-letting has pre-
ceded its exhibition. I have supposed the stimulus from
the remote  causes of the yellow fever to be equal in force
to five, and that  of mercury to three.   To enable  the
mercury  to produce its action upon the system,  it is ne-
cessary to reduce the febrile action, by bleeding, to two
and a half,  or below it, so that the stimulus of the mer-
cury shall transcend it.   The safety of mercury, when
introduced  into the system, has three advantages as a  sti-
mulus over that of the matter which produces the fever.
1.  It excites an action in  the system preternatural only
in force.  It does not derange the natural order of actions.
2.  It determines the actions chiefly  to external  parts of
the body.  And,  3.  It  fixes them,  when it affects  the
mouth and throat, upon parts which are capable  of bear-
ing great inflammation and effusion without any danger
to life.   The stimulus which produces the yellow fever
acts in ways the reverse of those which have been men-
tioned.   It produces violent irregular or wrong  actions.
It determines them to internal parts of the body, and it
fixes them upon viscera which bear, with difficulty and
danger,  the  usual effects  of disease.   A  late French
writer, Dr. Fabre, ascribed to diseases a centrifugal, and
a centripetal direction. From what has been said it would
seem, the former belongs to mercury, and the  latter to
the yellow fever.
  Considering the great prejudices against blood-letting,
I have wished to  combat this fever with mercury alone.
But, for  reasons  formerly given, I have been afraid to
trust to it without the assistance of the lancet.  The cha-
racter of the fever, moreover, like that which the poet
has ascribed to Achilles, is of " so swift,  irritable, inex-
orable, and cruel" a nature, that it  would be unsafe to
rely  exclusively upon a medicine which is not only of less
   VOL. IV.                d 
26
AN  ACCOUNT OF THE
efficacy than bleeding, but often slow and uncertain in its
operation, more especially upon the throat and mouth.
   Let not the reader be offended at my attempts to rea-
son.   I am aware of the evils which the weak and per-
verted exercise of this power of the mind has introduced
into medicine.  But let us act with the  same consistency
upon this subject ihat we do in other things.
   We do not consign a child to its  cradle for  life, be-
cause it falls in its first  unsuccessful efforts to use its
legs.   In like  manner we must not abandon reason, be-
cause, in our first efforts to use it, we have been deceived.
A single just principle in our science will lead  to  more
truth, in one year, than whole  volumes of uncombincd
facts will do in a  century.
   I lost but two patients in this  epidemic  in whom the
mercury excited a salivation.  One of them died from
the want of nursing; the other by the late application of
the remedy.
                  OF EMETICS.

   It was said a practitioner, who was opposed to bleed-
ing and mercury, cured this fever by  means of  strong
emetics.   I gave one to a man who refused to  be bled.
It operated freely, and brought on a plentiful sweat. The
next day he arose from his bed and went  to his work.
On the fourth day he sent for  me again  My son visited
him, and found him without a pulse.   He died the next
day.
   I heard of two other persons who took emetics in the
beginning of the fever, without the advice of a physician,
both of  whom died.
   Dr. Pinckard informed me,  that their effects were ge-
nerally hurtful  in the violent grades of the yellow fever
in the West-Indies.   The same information has  since
been given to me by  Dr.  Jackson.  In the second and
third grades of the bilious fever they appear not only to
be safe, but useful. 
BILIOUS YELLOW FEVER OF 1797.       27
             OF DIET AND DRINKS.

  The advantages of a weak vegetable  diet were  very
great in this fever.   I found but little difficulty, in  most
cases, in having my prohibition of animal food complied
with before the crisis of the fever,  but there  was  often
such a sudden excitement of the appetite  lor  it, imme-
diateh  afterwards, that it was difficult to restrain  it.  I
have mentioned the case of a young man, who was upon
the  recovery, who died in consequence of  supping-upofi
beef-siakes.   Many other instances of the mortality of
this fever from a similar cause, 1 believe, occurred in our
epidemic, which were concealed from our physicians  I
arn  not singular in ascrib.ng  the death of convalescents
to the too early use of animal food.  Dr. Poissonnier has
the  following important remark upon this subject " The
physicians of Brest have observed,  that the relapses in
the  malignant fever, which prevailed in their naval hos-
pitals, were  as much the effect of a fault in the diet of
the  sick as of the contagious air to which  they were ex-
posed, and that as many patients perished from this cause
as from the original fever.   For this reason light soups,
with leguminous  vegetables in them, panada, rice season-
ed with cinnamon, fresh eggs, &c. are all that they should
be permitted to eat.   1 he use  of flesh should be forbid-
den for many days after the entire cure of the disorder."*
  Dr. Huxham  has furnished  another evidence of the
danger from the  premature use of  animal food, in his
history of a m.ili mant fever which prevailed at Plymouth,
in the year 1740    u If any one (*ays the  doctor) made
use of a flesh or fish diet, before he had been  very well
purged, and his recovery confirmed, ht infallibly indulged
himself herein at  the utmost danger of his life."f
  In addition to the miid articles of diet, mentioned by
Dr. Poissonnier,  I  found bread and milk, with a little
water,  sugar, and the pulp of a  roasted apple mixed with
it, very acceptable to my patients during their  convales-
cence. Oysters were equally innocent and agreeable.  Kipe
grapes were devoured by them with avidity, in every stage
  • Mala.'i.-s de Gens de Mer, vol. i. p. 345.
  \ Epidemics, vol. ii. p. b7. 
2&              AN ACCOUNT OF THE

of the fever.  The season had been favourable to the
perfection of this pleasant fruit, and all the gardens in the
city and neighbourhood  in which it was cultivated were
gratuitously opened by the citizens for the benefit of the
sick.
  The drinks were, cold water, toast and water, balm tea,
water in which jellies of different kinds had been dissolved,
lemonade, apple water, barley and  rice  water, and, in
ca-,es where the stomach was affected with  sickness or
puking, weak  porter and water, and  cold camomile tea.
In the convalescent stage of  the fever, and in such of its
re:» issions or  intermissions as were  accompanied with
great languor in the pulse, wine-whey, porter and water,
and brandy and water, were taken with advantage.
  Cold water  applied to  the body, cool and fresh air, and
cleanliness, produced their usual good effects in this fever.
In the external use of  cold water, care was taken to con-
fine it to such cases as were accompanied with preterna-
tural heat, and to forbid it in the cold fit of the fever, and
in those cases which were attended with cold hands and
feet, and where the disease showed a disposition to ter-
minate, in its  first  stage,  by a  profuse perspiration.  It
has lately given me great pleasure to  find the same prac-
tice, in the external use of cold water in  fevers, recom-
mended by Dr. Currie of Liverpool, in his  medical re-
ports of the effects of  water, cold and warm,  as a remedy
in febrile diseases.   Of the benefit of fresh air in this
fever, Dr. Dawson of Tortola has lately furnished me
with a striking instance.   He informed me,  that by re-
moving patients from  the low grounds  on  that island,
where the fever is generated, to a neighbouring mountain,
they generally recovered in a few days.
   Finding   a  disagreeable smell to arise from vinegar
sprinkled upon the floor, after it had emitted  all its acid
vapour, I directed the  floors of sick rooms to be sprink-
led only with  water.   I  found the vapour which  arose
from it to be more grateful to my  patients.   A citizen of
Philadelphia,  whose  whole  family recovered from the
fever,  thought  he perceived  evident  advantages  from
tubs of fresh  water being kept constantly  in the sick
rooms. 
BILIOUS YELLOW FEVER OF 1797.        89
        OF STIMULATING REMEDIES.

  There were now and then remissions and intermissions
of the fever, accompanied with such signs of danger from
debility, as to  render the exhibition of a few drops of lau-
danum, in a little wine-whey, a glass of brandy and water,
and, in  some instances,  a  cup  of weak  chicken-broth,
highly neces&ary and useful.  In addition to these cordial
drinks,  I directed the feet to be placed in a tub of warm
water, which was introduced under the bed clothes, so
that the patient was not weakened by being raised from
a horizontal posture.  All these remedies were laid aside
upon a  return  or a paroxysm of fever.
  I did not prescribe bark  in a  single case of this dis-
ease.   An  infusion of the  quassia root was substituted
in its room, in several instances, with advantage.
  Blisters were applied as usual, but, from the insensibi-
lity of the skin, they were  less effectual than applications
of mustard to the arms and legs.   It is a circumstance
worthy of notice, that while the stomach, bowels, and even
the large blood-vessels are sometimes in a highly excited
state, and overcharged, as it were, with life, the whole sur-
face  of  the body is in a state of the greatest torpor. To
attempt  to excite it by internal remedies is like adding fuel
to a chimney already on fire. The excitement of the blood-
vessels, and the circulation of the blood, can only be equa-
lized by the application of  stimulants to the skin. These,
to be effectual, should  be of the most powerful  kind.
Caustics might probably be used in such cases with advan-
tage. I  am led to this opinion by a fact communicated to
me by Dr. Stewart.   A  lighted candle, which had been
left on the  bed of a woman whom he was attending in the
apparent last stage of the yellow fever, fell upon her breast.
She  was too insensible to feel, or too weak to remove it.
Before her nurse came into her  room, it had made a deep
aiid extensive impression upon  her flesh.  From that time
she revived, and in the course of a  few days  recovered.
As a tonic remedy in this fever, Dr. Jackson has spoken
to me in high terms of the  good effects of riding in a car-
riage.  Patients,,he  informed me, who were moved with
difficulty, after riding a few miles were able to sit up, and 
30
AN ACCOUNT OF THE
when they returned from their excursions, were frequently
able to walk to their beds.
   Much has been said, of late years, in favour of the ap-
plication of warm olive oil to the body in the plague, and
a wish lias been expressed, by some people, that its effi-
cacy might be tried  in the yellow fever.  Upon examining
the account of this remedy, as published by Mr. Baldwin,
three things suggest themselves to our notice.  1. That the
oil i^ effectual only in the forming state of the disease;
2. That the friction which is used with it contributes to
excite the torpid vessels of the skin; and 3. That it acts
chiefly by depleting from the pores of the body.  From the
unit} of the remedy of depletion, it is probable purging or
bleeding might be  substituted to the expensive parade of
the sweat induced by the  warm oil, and the smoke of
odoriferous vegetables. But 1 must not conceal here, that
there are facts which favour an idea, that  oil produces a
sedative action upon the blood-vessels, through the me-
dium of the skin.   Bontius  says it is used in this  man-
ner in the East-Indies, for the eure of malignant fevers,
after the previous use  of bleeding and purging.  It seems
to have been a remedy  well known among the Jews; hence
we find the apostlfe Jiimes advises its being applied to the
body, in addition to  the prayers of the elders of the church,*
It is thus in other cases, the  blessings of heaven are con-
veyed to men through the use of natural means.
   During the existence of the premonitory symptoms,
and before patients were confined to their rooms, a gen-
tle purge, or the loss of a few ounces  of  blood, in  many
hundred instances,  prevented the formation of the fever.
I did not meet with a  single  exception to this remark.
   Fevers are  the affliction chiefly of  poor people.  To
prevent or to  cure  them,  remedies  must be cheap, and
capable of being applied with but little attendance. From
the affinity established by the Creator between  evil and
its antidotes, in other  parts of his works, I am disposed
to believe no  remedy will ever be effectual in any  gene-
ral disease, that is  not cheap, and that cannot  easily be
made universal.
   it is to be lamented that the greatest part of all the deaths
which occur, are from diseases that are under the power of
                    * Chapter v- verse 14 
BILIOUS YELLOW FEVER OF 1797.
31
medicine.  To prevent their fatal issue, it would seem to
be agreeable to the order ot  Heaven in other things, that
they should be attacked in their forming state.   Weeds,
vermin, public oppression, and private vice, are  easily
eradicated and destroyed, if opposed by their proper re-
medies, as soon as they show  themselves. The principal
obstacle to the successful use  of the antidotes of malig-
nant fevers, in their  early stage,  arises from physicians
refusing to declare when they appear in a city, and from
their practice of calling their mild forms by  other names
than that of a mortal epidemic.
   I shall now say a  few  words upon the  success  of the
depleting practice in this tpidemic.
   From the more malignant state of the fever, and from
the tears and prejudices that were excited against bleeding
and mercury  by  means of the newspapers, the success of
those remedies was  much less than in  the years 1793 and
 1794.  Hundreds refused to  submit to them at the time,
and in the manner, that  were necessary to render them
effectual.   From the publications of a number of physi-
 cians, who used the lancet and mercury in their greatest
extent, it appears that they lost but one in ten of all they at-
 tended.  It was said  of several practitioners who were op-
 posed to copious bleeding,  that they lost a much smaller
 proportion  of their patients with the prevailing  lever.
 Upon inquiry it appeared they had lost many more.  To
 conceal their want of success, they said their patients had
 dieu of other diseases. This mode of deceiving the public
 began in 1793.  The men who used  it did not recollect,
 that it is less in favour of a physician's skill to lose pa-
 tients in pleurisies,  colics, haemorrhages, contusions, and
 common remittents, than in a malignant yellow fever.
    Dr. Sayre attended fifteen  patients in the disease, all of
 whom recovered by the plentiful use of the depleting re-
 medies.  His place of residence being remote from those
 parts of the city in which the fever prevailed most, pre-
 vented his  being called  to a greater number of cases.
    A French physician,  who bled and purged moderately,
 candidly acknowledged that he saved  but  three  out of
 fear of his patients.
    In the city hospital, where bleeding was sparingly used,
 and where the physicians depended chiefly  upon a saliva- 
32
AN ACCOUNT OF THE
 tion, more than one half died of all the patients who were
 admitted.  It is an act of justice to the physicians oi the
 hospital to add, that many, perhaps most of their patients,
 were admitted after the first day of the disease.
   I cannot conclude this comparative view of the success
 of the different modes of treating the yellow fever, with-
 out taking notice, that  the stimulating mode as recom-
 mended by Dr. Kuhn and Dr. Stevens, in the year 1793,
 was deserted by even ph) sician in  the  city.  Dr.  Ste-
 vers acknowledged the disease to require a different treat-
 ment from that which is  required in the West-Indies;
 Dr. Kuhn adopted the lancet and mercury  in  his prac-
 tice; and several other physicians, who had written against
 those remedies, or who had doubted of their safety,  and
 efficacy in 1793, used them with confidence, and in  the
 most liberal manner, in 1797.
   In the histories I have given of the yellow fevers of
 1793 and 1794, I have scattered here and there a few ob-
 servations upon their degrees of danger, and  the signs
 of their favourable or unfavourable issue.  I shall close
 the present history, by  collecting those observations into
 one view, and adding to them such other signs as  have
 occurred to me in observing this epidemic.
   Signs of moderate danger, and a favourable issue of
 the yellow fever.
   1.  A chilly fit accompanying the attack of the fever.
 The longer this chill continues, the more favourable the
 disease.
   2.  The recurrence of chills every day, or twice a day,
 or every other day, with the return of  the exacerbations
 of  the fever.   A coldness of the whole body, at the
 above periods,  without chills, a coldness with a profuse
 sweat, cold feet and hands, with febrile heat in other parts
 of the body, and a profuse sweat without chills or cold-
ness, are all less favourable symptoms than a regular chil-
ly fit, but they indicate less danger than their total ab-
sence during the course of the fever.
   3.  A puking of green or yellow bile on the first day of
 the disease is favourable.   A discharge of black bile,  if it
 occur on the first day of the fever, is not unfavourable*
   4.  A discharge of green and yellow  tfools.  It is more
favourable if the stools are of a dark or black colour,  and 
2ULI0US YELLOW FEVK8. OF 1797.       33y
 of a foetid and acrid nature, on the first or second day of
 the fever.
   5.  A softness or moisture on the skin in the beginning
 of the fever.
   6.  A sense of pain in the head, or a sudden translation
 of pain from internal to external parts of the body,  par-
 ticularly to the back. An increase of pain after bleeding.
   7.  A sore mouth.
   8.  A moist white, or a yellow tongue.
   9.  An early disposition to spit freely, whether excited
 by nature or the use of mercury.
   10.  Blood becoming sizy, after having  exhibited the
 usual marks of  great morbid action  in the blood-vessels.
   11.  Great and exquisite sensibility in the sense of feel-
 ing coming on near the close of the fever.
   12.  Acute pain in the back and limbs.
   13.  The appearance of an inflammatory spot on a fin-
 ger or toe, Dr. H. M'Clen  says, is favourable.   It ap-
 pears,  the doctor says, as if the cause of the fever  had
 escaped by explosion.
   Signs of great danger, and  of an unfavourable issue
 of the yellow fever are,
   1. An attack of the fever, suddenly succeeding great
 terror, anger, or the intemperate use of venery, or strong
 drink.
   2. The first paroxysm coming on without any premo-
 nitory symptoms,  or a chilly fit.
   3.  A coldness over the whole body without  chills for
 two or three days.
   4. A sleepiness on the first and second days of the fever,
   5. Uncommon paleness of the face not induced by blood-
 letting.
   6. Constant or violent vomiting, without any discharge
 of bile.
   7. Obstinate costiveness, or a discharge of natural, or
white stools; also quick, watery stools after taking drink.
   8. A diarrhoea towards the olose of the fever.  I lost
two patients, in  1797, with this symptom, who had exhi-
bited, a few days before, signs of a recovery. Dr. Pinckard*
 informed me, that  it was generally attended with a fatal
 issue in the yellow fever of the West-Indies. Diemerbrosck
   vol. iv.                E 
34              AN  ACCOUNT OF THE
declares, that " scarcely one in a hundred recovered, with
this symptom, from the plague."*
  9. A suppression of urine.   It is most alarming when
it is without pain.
  10.  A discharge of dark  coloured and bloody urine.
  11.  A cold, cool, dry, smooth, or shining skin.
  12.  The appearance of a yellow colour in the face on
the first or second day of the fever.
  13.  The absence of pain, or a sudden cessation of it,
with the common  symptoms of great danger.
  14.  A disposition to faint upon a little  motion,  and
fainting after losing but a few ounces of blood.
  15.  A watery, glassy,  or brilliant eye.  A red eye on
the fourth or fifth  day of the disease.  It is more alarming
if it become so after  having been previously yellow.
   16.  Imperfect vision, and blindness in the close of die
disease.
   17.  Deafness.
  18.  A preternatural appetite, more  especially  in  the
last stage of the fever.
   19.  A slow, intermitting, and shattered pulse.
  20.  Great restlessness, delirium,  and long continued
coma.
  21.  A discharge of coffee coloured or  black  matter
from the stomach, after the fourth day  of the fever.
  22.  A smooth red tongue, covered with a lead-colour*
ed crust, while  its edges  are of a bright red.
  23.  A dull vacant face, expressive of distress.
   24.  Great insensibility to common  occurrences,  and
an indifference about the issue of the disease.
   25. Uncommon serenity of mind accompanied  with
an unusually placid countenance.
   I shall conclude this head by the following remarks:
   1. The violence, danger, and probable  issue of  this
fever, seem to be in  proportion to the duration and force
of the predisposing and exciting causes. However steady
the former are in  bringing  on  debility, and the latter in
acting as irritants upon  accumulated excitability, yet a
knowledge of their duration and force is always useful, not    b ,
only in forming an opinion of the probable issue of the
fever, but in regulating the force of remedies.
* Lib- i. cap. 15. 
         BILIOUS YELLOW FEVER 6F  1797.        4ft

  2. The signs of danger vary  in  different  years, from
the influence of the weather upon the disease.
  3. Notwithstanding the signs of the favourable and
unfavourable issue of the fever,  are in general uniform,
when the cure of the disease is committed to nature, or
to tonic medicines, yet they are  far from being so  when
the treatment of the  fever is taken  out  of the hands of
nature, and attempted by the use of depleting remedies.
We often see patients recover with  nearly all the  unfa-
vourable symptoms that  have been  mentioned, and  we
sometimes  see them die, with all those that are favoura-
ble.   The  words of  Morellus,  therefore, which  he has
applied to  the plague, are equally true when applied to
the yellow  fever.   u In the plague, our senses deceive us.
Reason deceives us.   The aphorisms of Hippocrates de-
ceive us."*  An important lesson may be learned from
these facts, and that  is, never to  give a patient over. On
the contrary, it is our duty in this, as well as in all other
acute diseases, to dispute every inch of ground with death.
By means of this practice, which is warranted by science,
as well as dictated by humanity, the grave has often been
deprived for a while  of its prey,  and prelude thereby ex-
hibited of that approaching and  delightful time foretold
by ancient  prophets, when the  power of medicine over
diseases shall be such, as to render old age the only out.
let of human life.

  * De Feb. Pestilent, cap. v. " Acutorum morborum incertx admodum, »•
fallaces sunt prxdictiones"
                                         IIlPPOCRATIS. 
 
       AN ACCOUNT





           OF THE





BILIOUS YELLOW FEVER,




           AS IT





  APPEARED IN PHILADELPHIA,




       IN THE YEAR 1798. 
 
AN ACCOUNT, &c.
    THE yellow fever of the year 1797 was succeeded
by scarlatina, catarrhs, and bilious pleurisies, in the months
of November and December of the  same year.   The
weather favoured the generation of the latter diseases. It
became suddenly cold  about the middle of November.
On the 5th of December, the navigation of the Delaware
was obstructed.   There was a thaw on the 13th and 14th
of this month, but not sufficient to open the river.
  In the month  of January, 1798, the fevers discovered
an uncommon determination to the brain.  Four cases of
the hydrocephalic state of fever occurred under my care
during this month, all  of  which yielded to depleting re-
medies.  The  subjects of this  state  of fever were Mr.
Robert Lewis, and the daughters of Messrs. John Brooks,
Andrew Ellicott, and  David Maffat.
  The weather was variable during the months of Febru-
ary and March.   The navigation of the Delaware was not
completely opened until the latter end of February. The
diseases of these two months were catarrhs and  bilious
pleurisies. The former were confined  chiefly to children,
and were cured by gentle pukes, purges of calomel, and
blood-letting.  The last remedy was employed twice in a
child of Isaac Pisso, of six weeks old, and once in a child
of Thomas Billington, of three weeks old, with success.
  On the 7th of April, I visited Mr. Pollock, lately from
the state of Georgia, in consultation with Dr. Physick,
in a yellow fever.  He died the evening after I saw him,
on the third day of his disease.
   There was a  snow storm on the 16th of April, and the
weather was afterwards very cold.  Such leaves and blos-
soms as had appeared, were injured by it.
   On the 1st of May, the mercury in Fahrenheit's ther-
mometer rose to 84°.  The weather, during the latter part
of this month, and in  June, was very  dry. On the 6th of 
40
AN ACCOUNT OF THE
June, Dr. Cooper lost a patient in the yellow fever,  near
the comer of Twelfth and Walnut-streets.  Mark Miller
died with the same state of fever on the 2d of July. About
a dozen cases of a similar  nature  occurred, under the
care of different practitioners, between the 2d and  20th
of this month, and all  of them in parts of the  city re-
mote from Water-street.
   On the 19th of July, the weather was  so cool as to
render winter clothes comfortable.  A severe hail storm
had occurred, a few days before,  in the  neighbourhood
of Wilmington, in the Delaware state.
   On the 21st of the month, the ship Deborah arrived
from one of the West-India islands, and discharged her
cargo in the city.  She was moored afterwards at Ken-
sington, where the foul air  which was emitted from her
hold produced several cases  of yellow fever,  near the
shores of  that village.
   In August the disease appeared in nearly every part of
the city, and particularly in  places where  there  was the
greatest exhalations from foul gutters and common sewers.
   In describing the disease, as it appeared this year, I shall
take notice of its symptoms as they appeared in the blood-
vessels, alimentary canal, the tongue, the nervous system,
in the eyes,  the lymphatic system, and the blood.
  The subjects  which  furnished the  materials  for this
history were not  only  private patients, but the  poor in
the city hospital, who were committed to the care of Dr.
Physick and myself, by the board of health.
   I.  The pulse  was, in many cases, less  active in the
beginning of this fever than in former years.  It was sel-
dom preternaturally slow.  It resembled the pulse which
occurs in the first stage of  the common jail fever.   Hae-
morrhages were common about the  fourth and fifth days,
and generally from the gums, throat, or stomach.
  II. The whole alimentary canal was much affected  in
most cases.   Costiveness and a  vomiting were general.
The alvine discharges were occasionally green, dark-co-
loured, black, and natural.  The black vomiting was more
common this year than in former years, in all the forms of
ihe fever.   It was sometimes suspended for several days
before death, and hopes were entertained of a recovery of
patients in whom it had appeared.   In a boy, at the city 
BILIOUS YELLOW  FEVER OF 1798.       41
hospital, it ceased ten days before he died. It was some-
times succeeded by delirium or coma, but it more com-
monly left the patient free of pain, and in the possession
©f all the faculties of his mind.
  III. The tongue was by no means an index of the state
of the fever, as in the years 1793 and  1797. 1 saw several
deaths, attended with a biack vomiting, in which the tongue
retained a natural appearance.  This  phenomenon at first
deceived me.  I ascribed it to such a concentration of the
disease in the stomach and other vital parts, as to prevent
its diffusing itself through the external parts of the system.
We observe the effects of the same cause in a natural state
of the skin, and  in a natural appearance of the urine,  in
the most malignant forms  of this fever.
  IV. In the nervous system,  the disease appeared with
several new symptoms. A relation of Peter Field attempt-
ed to bite his attendants in the delirium of his fever, just
before he died.
  I attended a young woman at Mrs. Easby's, who started
every time I touched her pulse. Loud talking, or a ques-
tion  suddenly proposed to her, produced the same  con-
vulsive motion.  She retained her reason during the whole
of her illness,  and was cured by bleeding and salivation.
  Hiccup was a  common  symptom.   I saw but two pa-
tients recover who had it.   In one of them, Dr. Hedges,
it came on after the  sixth day of the fever, and continued
without any other symptom of disease, for four or live*
days.
  I lost a patient who complained of no pain but in the
calves of his legs. Dr. Physick lost a girl, in the city hos-
pital, who complained only of pains in her toes.   Her sto-
mach discovered, after death, strong marks of inflamma-
tion.
  Many people passed through every stage of the disease,
without uttering a complaint of pain  of any kind.
  An uncommon stiffness in the limbs preceded death a
few hours, in several cases.  This stiffness ceased, in one
of Dr. Physick's patients, immediately after death,  but
returned as soon as he became cold.
  An obstinate wakefulness continued through the whole
ef the disease in Dr. Leib.  It was common during the
convalescence, in many eases,
  VO*L.  TV.                     F 
42
AN  ACCOUNT OF THE
  The whole body  was affected, in many cases, with a
morbid sensibility, or what has been called :>upersensation,
so that patients complained or pain upon being touched,
when they were moved in their bids. This extreme sensi-
bility was general in parts to which blisters had been ap-
plied.   It continued through every stage of she disease.
Dr.  Physick inforn.ed me, that he observed it in a  man
two  hours before he died   In this man there was an ab-
sence of pulse, and a coldness of his exiremities.  Upon
touching his wribt,  he cried out as if he felt great pain.
   V. A redness in the eyes was a general symptom.  I
saw  few recoveries where this redness was not removed.
   A discharge of matter from one ear relieved Mr. J C.
Warren from a distressing pulsation of the arteries in his
head.
   VI. Glandular swellings occurred in several instances.
Two cases of them came under my notice.  They  both
terminated favourably.
   VII. The blood  had its usual appearance in this dis-
ease.  In the yellow lever which prevailed  at the same
time in Boston, Dr. Rand says the blood was sizy in but
one  out of a hundred cases.
   The forms of the fever were nearly similar to those
which have been described in the year 1797.  I saw seve-
ral cases in  which the disease appeared in the form  of a
tertian fever.  In one of them it tern inated in death.
   The system, in many cases, was prostrated below the
point of inflammatory re-action.    rl hese were called, by
some practitioners,  typhous fevers.  It was the most  dan-
gerous and  fatal form of the c.isease.  Its frequent occur-
rence gave occasion to remark, that our epidemic resem-
bled the yellow  fever  of the West-Indies,  much  more
than the fevers of 1793 and. 1797.
   I  attended two patients in whom the disease was  pro-
tracted nearly to the 30th day.  They both recovered.
   Dr. Francis Sajre  informed me, that he saw a child,
in which the morbid afftction of the  wind-pipe, called
cynanche trachealis, appeared with all the usual symptoms
of yellow fever.
   t attended one case  in which the force of  the disease
was  weakened, ini ts first stage, by a profuse haemorrhage 
BILIOUS YELLOW FEVER OF 1798.
43
from the bowels.  This haemorrhage was followed by a
bloody diarrhoea, which continued for four or five weeks.
   Persons of all ages and colours were  affected  by this
fever.  I saw a case of it in a child of six months old. In
the blacks, it was attended wiih less violence and mortal-
ity than in white people.  It affected many persons  who
had previously had it.
   The disease was excited  by the same  causes which
excited it in former years.  1 observed a number of peo-
ple to be affected by  ihe fever, who lived  in solitude in
their houses,  without doing  any business.   The system,
in these persons, was predisposed to the disease, by the
debility  induced by ceasing  10 labour at their former oc-
cupations.  It wavs excited in  a young man by a fractured
leg.  He died five days afterwards, with a black vomit-
ing.  1 observed, in several instances, an interval of four
and five days between the debility induced upon the sys-
tem by a predisposing, and the  action of  an  exciting
cause.  Dr. Clark says, he has seen an interval of seve-
ral  weeks between the operation of  those causes,  in the
yellow fever,  of  Dominique.  These facts are worthy of
notice, as they lead to a piotracred use of the  means of
obviati.g an attack of the disease.
  During my attendance upon the sick, I twice perceived
in my system the premonitory signs of the epidemic. Its
complete formation was prevented each  time by rest, a
moderate dose of physic, and a plentiful sweat.
   I shall now take notice of the different manner in which
patients died  of  this  fever.  The  detail  may be useful,
by  unfolding new principles in the  animal economy, as
well as new facts in the history of the disease.
   1. The disease terminated in death, in some instances,
by means of  convulsions.
  2. By delirium, which prompted to exertions and ac-
tions similar to those which take place in madness.
  3. By profuse heemorrhages from the  gums. This oc-
curred in two patients of Dr Stewart.
  4. By an incessant vomiting and  hiccup.
   5. By extreme pain in the calves of the legs and toes,
which, by destroying the excitement of  the  system, de*
stroyed life. 
44
AN ACCOUNT OF  THE
   6.  By a total absence of pain.   In this way it put an
 end to the life of Mr. Henry Hill.
   7.  By a disposition  to easy, and  apparently natural
 sleep.  I have reason to believe that Mr. Hill encouraged
 this disposition to sleep, a few hours before he died, un-
 der the influence of a belief that he would be refreshed
 by it.  Diemerbroeck says the plague often killed in the
 same way.
   8.  The mind was in many cases torpid, where no de-
 lirium attended, and death was submitted to  with a de-
 gree of insensibility, which  was often mistaken for forti-
 tude  and resignation.
   I shall now mention the morbid appearances exhibited
 by the bodies of persons who died of this fever, as com-
 municated to me by my friend, Dr. Physick; being the
 result of numerous dissections made by him at the city
 hospital.
   In  all of them the stomach was inflamed  The matter
 which constitutes what is called the black vomit, was found
 in the stomachs of several patients who had not discharged
 it at any time by vomiting.  In some stomachs, he found
 lines  which seemed to separate the living from their dead
 parts.   Those  parts,  though dead, were not always in
 a mortified state. They were distinguished from the living
 parts  by a peculiar paleness, and by discovering a  weak
 texture upon being pressed between the fingers. He ob-
 served the greatest marks of inflammation in the stomachs
 of several persons in whom  there had been  no vomiting,
 during the^whole course of  the disease.  The brain in a
 few instances, discovered marks of inflammation.  Water
 was now and then found in its ventricles, but always of its
 natural colour,  even in those persons whose  skins were
 yellow.  The liver suffered  but little in this disease.  It
may serve to increase our knowledge of the influence of
local circumstances upon epidemics to remark,  that this
viscus, which was rarely diseased in the fever of Phila-
delphia  in 1798, discovered marks of  great inflammation
in the bodies which were examined by Dr. Rand and Dr.
Warren, in the  town of Boston, where the yellow fever
prevailed at the same time it did in Philadelphia.
   The weather was hot and dry in August and September,
during the prevalence of this fever.   Its influence upon 
          BILIOUS YELLOW FEVER OF 1798.       4$

■animal and vegetable life are worthy of notice. Mosche.
toes abounded, as usual in sickly seasons; grasshoppers
covered the ground in many places; cabbages and other
garden vegetables, and even fields of clover, were devoured
by them.   Peaches ripened this year three weeks sooner
than in ordinary summers, and apples rotted much sooner
than usual after being gathered  in the autumn.   Many
fruit-trees blossomed in October, and a second  crop  of
small apples and cherries were seen in November, on the
west side of Schuylkill, near the city.  Meteors were ob-
served in several places.  On the 29th of September there
was a white frost.  Its effects upon the fever were obvious
and general.   It declined, in  every part  of the city,  to
such a degree as to induce many people to return from
the country.   In the beginning of October the  weather
again became  warm, and the disease revived.   It was
observable, that all great changes in the weather from heat
to cold that were less than  that  degree which produces
frost, also of cold to heat, increased the mortality of the
fever.  It spread most  rapidly in moist weather.
  The origin of this fever was from the exhalations  of
gutters, docks, cellars, common sewers, ponds of stagnat-
ing water, and from the foul air of the ship formerly men-
tioned.
  The fever prevailed at the  same time in the town  of
Chester, in Pennsylvania;  in  Wilmington, in  the state of
Delaware;  in New-York, in New-London, in Connecti-
cut;  in  Windsor,  in Vermont; and  in Boston;  in all
which places its origin was traced to domestic sources.
  I shall now  deliver a short account of the remedies em-
ployed in the cure  of this disease.
  I have said  that the pulse was less active in this fever
than in the fevers of former years.  It was seldom, how-
ever, so feeble as to forbid  bleeding.   In Dr. Mease it
called for the loss of 162 ounces of blood, and in Mr. J.
C. Warren for the loss of 200, by successive bleedings,
before it was subdued.  But such cases were not common.
In most of them, the pulse flagged after two or three
bleedings. But there were cases in  which the lancet was
forbidden altogether. In these the system appeared to be
prostrated, by the force of the miasmata, below the point
of re-action.  This state of the disease manifested itself iu 
46
AN ACCOUNT OF THE
a weak, quick, and frequent pulse, languid eye, sighing,
great inquietude, or great insensibility.  However unsafe
bleeding was on the first day of this fever,  when it  ap-
peared with those symptoms, nature often performed that
operation upon herself from the gums, on the fourth  or
fifth day.   I saw several pounds of blood discharged  on
those days, and in that way, with the happiest effects.  It
appeared to take place after the revival of the blood-ves-
sels from their prostrated state.
   From a conviction  that the system was depressed only
in these cases, and finding that i; did not rise upon blood-
letting,  I resolved to try the effects of emetics, in exciting
and equalizing the  action of the blood-vessels.  The ex-
perience 1 had had of ihe inefficacy of this remedy in 1793,
and of its ill effects in one instance in 1797, led me to
exhibit  it with a trembling hand.   I gave it for the first
time to  a son of Richard Renshaw.  I had bled  him but
once, and had  in vain  tried to bring on a salivation.  On
the fifth day of his disease, his  pulse became languid and
slow, his skin cool, a  haemorrhage had taken place from
his gums, and he discovered a  restlessness  and  anxiety
which I had often seen, a few hours before death.  He
took four grains of tartar emetic, with twenty grains of
calomel, at two doses.  '1 hey  operated powerfully,  up-
wards and downwards, and brought away a large quantity
of bile. The effects of this medicine were such as I wished.
The next day he was out of danger.  I prescribed the same
medicine in many other cases with the same  success.  To
several of my patients I gave two emetics in the  course
of the disease.  Some of them discharged bile resembling
in viscidity the white  of an egg.   But I saw one case in
which great relief was obtain d fro n the operation of an
emetic,  where no bile was discharged.
   In the exhibition of this remedy, I was regulated by the
pulse.   If  1 found it  languid on the first day of the fever,.
I gave it before any o her medicine.  When it was  full
and tense, I deferred  it until I had reductd  the pulse to
the emetic point by bleeding and purges. 1 observed, with
great pleasure, that mercury affected  the  mouth more
speedily and certainly  where an emeric had been adminis-
tered, than in other cases, probably from awakening,  by
its stimulus, the sensibility of the stomach;  for such was 
BILIOUS YELLOW FEVER OF 1798.       47
its torpor, that in one case ten grains of tartar emetic, and
in another thirty grains, did not operate upon it, so as to
exeite even ihe slightest degree of na  sea.
  In many cases, an emetic, given  in the forming  state
of the disease, seemed to effect an immediate cure.
  Purges produced the same salutary effects that they did
in formtr years.   I always combined calomel with them
in ihe first stage of the disease.
  A salivation was found  to be the most certain remedy
of any that was used in this fever.   I did not lose a sin-
gle  patient, in whom the mercury acted upon the salivary
glands.   It was  difficult to excite it in many cases, from
the  mercury being rejected by  the stomach, from its pas-
sing off by the bowels, or from its stimulus being ex-
ceeded by the morbid  action in the blood-vessels.
  Bleeding rendered the action of the mercury  upon the
mouth more speedy  and more certain,  but I saw several
cases in which a salivation was excited in the most malig-
nant forms of the fever, where  no blood had been drawn.
It will not be difficult to explain the reason of this fact if
we  recur to what was said formerly of the prostration of
the  system in this fever.   In  its worst forms, there  is
often a total absence, or a  feeble degree of action in the
blood-vessels, from an excess of the stimulus of the re-
mote cause of the fever.   Here the mercury meets with
no resistance  in  its tendency to the  mouth.  Bleeding in
this case would  probably do harm,  b}  taking off a part
of the pressure upon the system, and thereby  produce a
re-action in the vessels, that might  predominate over the
action of the  mercury.  The disease here  does that for
us by its force, which, in  other cases,  we  effect by de-
pleting remedies.
  Where the mercury showed a disposition to pass too ra-
pidly through the bowels,  I observed no inconvenience
from combining it with opium, in my attempts to excite
a salivation.  The calomel was constantly aided by mer-
curial ointment, applied by friction to different parts of
the body.
  Now and then a  salivation  continued for weeks and
months after the crisis of this fever, to the great distress of
the patient, and injury of the ere dit of mercury as a remedy
in this disease.  Dr. Physick has discovered, that in these 
48
An  account of the
cases the salivation is kept up by carious teeth or bone,
and that it is to oe cured only by removing them.
  From the impracticability  of exciting a salivation in
all cases, I attempted the cure of this fever,  after bleed-
ing,  by means of copious sweats.  They succeeded in
several instances where no other remedy promised or af-
forded any relief.   They were excited by  wrapping the
patient in a blanket, with half a dozen hot bricks wetted
with vinegar, and applied to different partsjof the body.
The sweating was continued for six hours, and repeated
daily for four or five days.
  In those cases where the fever put on the form of an
intermittent, 1 gave bark after bleeding and purging with
advantage.  I gave it likewise in all those cases where
the fever put on the type of the slow chronic fever. Laud-
anum  was acceptable and useful in many cases of pain,
wakefulness, vomiting, and diarrhoea, after the use of de-
pleting remedies.
  1 applied  blisters in the usual way in this  fever, but I
think with less effect than in the yellow fevers of former
years.
  To relieve a vomiting, which was very distressing in
many cases  about the fourth and fifth days, 1 gave a julep,
composed of the salt of tartar and laudanum. I also gave
Dr. Hosack's anti-emetic medicine, composed of equal
parts of lime-water and milk.  I do not know that it saved
any lives, but I am sure it gave ease by removing a pain-
ful symptom, and thus,  where it did not  cure,  lessened
the sufferings of the sick.
  The diet and drinks were the same in this fever as they
were in the  fevers formerly described.
  Cool air,  cold water,  and cleanliness produced their
usual salutary effects in this fever.
  I shall now deliver a  short account of  the symptoms
which  indicated a favourable and an unfavourable issue
of the disease.
  It has been said,* that the signs of danger vary in this
fever, from the influence of the weather.  The autumn of
1798 confirmed, in many instances,  the truth of this re-
mark.
                • History of the Fever in 1797. 
BILIOUS YELLOW FEVER OF 1798.       4Q
   I saw three recoveries after convulsions in the year 1798.
 All died who were convulsed in 1793 and 1797.
   A dry, hoarse, and sore throat was followed by death in
 every case in which it occurred in my practice.  In the
 fever of 1793 a sore throat was a favourable sign.  It was
 one of the circumstances which determined me to use a
 salivation in that  fever.
   Tne absence of pain was always a bad sign.  Small
 but frequent stools, and a continuance of a redness in the
 eyes after the ample use of depleting remedies, were like-
 wise bad signs.
   An appetite for food on the  fourth or fifth day of the
 fever, without a remission or cessation of the fever, was
 always unfavourable.
   A want of delicacy, in exposing parts of the body which
 are usually covered, was a bad symptom.  I saw but one
 recovery where  it  took place.   Boccacio says the same
 symptom occurred in the plague in Italy. " It suspended
 (he tells us) all modesty, so mat young women, of great
 rank and delicacy, submitted to be attended,  dressed, and
 even cleansed by male nurses.
   I have remarked, in another place, that but two of my
 patients recovered who had the hiccup.
   A dry tongue was a bad sign. I saw but one recovery
 where it occurred, and none where the tongue was black.
 A moist and natural tongue, where symptoms of violence
 or malignity appeared in other parts of the body, was
 always followed by a fatal issue of the disease
   A desire to ride out, or to go home, in persons who were
 absent from their families, was in every instance where
 it took place, a fatal symptom.  These desires arose from
 an insensibility to pain, or a false idea of the state of the
 disease.  It existed to such a degree in some of the pa-
tients in the city hospital, that they often left their beds,
and dressed themselves, in order to go home.  All these
patients died, and some  of them in the act of putting on
their clothes.
   From the history that has been given of the symptoms,
treatment, and prognosis of this fever, we see how imper-
fect all  treatises  on epidemics  must be, which are not
connected with climate and season.  As well might a tr*-
   vol. iv.                o 
50
AN ACCOUNT OF THE
veller describe a foreign climate, by the state of the wea-
ther, or by the productions of the  earth, during a single
autumn, as a physician adopt a uniform opinion  of  the
history, treatment, and prognosis of a fever, from its phe-
nomena in any one country, or during a single season.
  There were three modes of practice used in this epi-
demic.  The first consisted in the exhibition of purges of
castor oil, salts, and manna, and cooling glysters, and in
the use of the warm bath.  These remedies were prescri-
bed chiefly by the French physicians.  The second con-
sisted in the use of mercury alone, in such doses, and in
such a manner, as to excite a salivation. This mode was
used chiefly by an itinerant and popular quack. The third
mode consisted  in using all the remedies which I have
mentioned in the account of the treatment of this fever,
and accommodating them to the state of the disease. This
mode of practice was followed by most of the American
physicians.
  The first mode of practice was the least successful. It
succeeded  only in such cases as  would  probably have
cured themselves.
  The second mode succeeded in mild cases, and now and
then in that malignant state of the  fever, in which the ac-
tion of the blood-vessels was so  much prostrated by the
force  of the miasmata, as to permit the mercury to pass
over them, and thus to act upon  the salivary glands in the
course of four or  five  days.
  The last mode was by far the most successful.  It is
worthy of notice, that the business and reputation of the
physicians, during this epidemic, were in the inverse ratio
of their success.  The number of  deaths by it amounted
to between three and four  thousand, anion ar whom were
three physicians,  and  two students of medicine. Its mor-
tality was nearly as great as it was in 1793, and y^et the
number of people who were affected by  it Mas four times
as great in 1793 as it was in 1798, for, in the latter year,
the city was deserted by nearly  all its inhabitants.  The
cause of this disproportion of deaths to the number who
were  sick, was owing to the liberal and general use  of the
lancet in 1793, and  to the  publications in 1797 having
excited general fears and prejudices against it in  1798* 
         BILIOUS YELLOW FEVER OF 1798.       51

Such was the influence of these publications, that many
persons  who had recovered from this fever in the two
former years, by the use of depleting remedies, deserted
the physicians who had prescribed them, and put them-
selves under the care of physicians of opposite modes of
practice.   Most of them died.  Two of them had been
my patients, one of whom had recovered of a  third
attack of the fever under my care. 
 
       AN ACCOUNT





           OF THE






BILIOUS YELLOW  FEVER,





           AS It





  APPEARED IN PHILADELPHIA,





       IN THB YEAB 1799. 
 
AN ACCOUNT, &c.
    THE diseases which succeeded the fever of 1798,
in November and December, were highly inflammatory.
A catarrh was nearly  universal.  Several cases of sore
throat, and one of erysipelas, came under my care in the
month of November. The weather in December was ex-
tremely cold. It was equally so in the beginning of Janu-
ary, 1799, accompanied with several falls of snow.
  About the middle of the month, the weather moderated
so much as to  open the  navigation  of the Delaware.  I
met with  two cases of malignant cholic in the latter part of
this month, and one of yellow fever.   The last was Swen
Warner.  Dr. Physick, who attended him  with me,  in-
formed me that he had, nearly at the  same time, attended
two other persons with the same disease.
  The weather was very cold, and bilious pleurisies were
common, during the latter part of the month of  February.
  March was  equally cold.  The newspapers  contained
accounts of the winter having been uncommonly severe in
Canada, and in several European countries.
  The first two weeks in April were still cold.  The De-
laware, which had been frozen a second time during  the
winter, was crossed near  its origin, on the ice, on the 15th
day of this month. The diseases, though fewer than in the
winter, were bilious and inflammatory. During this month
I was called to a case of yellow fever, which yielded to co-
pious bleeding, and other depleting medicines.
  May was colder than  is usual in that month, but very
healthy.
  In the first week of June, several cases of highly bilious
fever came under my care. In one of them, all the usual
symptoms of the highest grade of that fever occurred.  On
the 13th of the month, Dr. Physick informed me, that he
had lost a patient with that disease.  On the 23d of  the
same month, Joseph Ashmead, a young merchant, died
of it Several other cases of the disease occurred between 
56              AN  account OF  THE
 the 20th and 29th days of the month, in different parts of
 the city.  About this time, I was informed that the inha-
 bitants of Keys's-alley had predicted a return of the yellow
 fever, from the trees before their doors emitting a smell,
 exactly the  same which they perceived just before the
 breaking out of that disease  in 1793.
   In July, the city was alarmed, by Dr. Griffitts, with an
 account of several cases of the fever in Penn-street, near
 the water.  The strictness with which the quarantine law
 had been  executed, for a while rendered  this account in-
 credible with many people, and exposed  the doctor to a
 good deal of obloquy. At length a vessel was discovered,
 that had arrived from one of the West-India islands on the
 14th of May, and one day before the quarantine law was
 put into operation, from which  the disease was said to be
 derived. Upon investigating the state of this vessel, it ap-
 peared that she had arrived with a healthy crew, and that
 no person had been sick on  board of  her during her
 voyage.
   In the latter part of July and in the beginning of August,
 the disease gradually disappeared from every part of the
 city.   This circumstance  deserves attention, as it shows
 the disease did not spread by contagion.
   About this time we were informed by the news-papers,
 that dogs, geese and other poultry, also that wild pigeons
 were  sickly in many parts of the  country, and that fish on
 the SusqueKannah, and oysters  in the Delaware bay, were
 so unpleasant that the inhabitants declined eating them.
 At the same time, flies were found dead in  great numbers,
 in the unhealthy parts of the  city.   The weather was dry
 in August and  September. There was no second crop of
 grass.  The gardens yielded a scanty supply of vegetables,
 and of an inferior size and quality. Cherries were smaller
 than usual, and pear and apple-trees dropped  their fruits
 prematurely,  in large quantities.  The peaches, which
 arrived at maturity, were small and ill  tasted. The grain
 was in general abundant, and of a good quality.   A fly, of
an unusual kind, covered the potatoe fields, and devoured
 in some instances, the leaves of the potatoe.  This fly has
lately been used with success in  our country, instead of the
fly imported from Spain. It is equal to it in every respect.
Like the Spanish fly, it sometimes  induces strangury. 
BILIOUS YELLOW FEVER OF 1799.        57
   About the middle of August the disease revived, and
appeared in different parts of the city.  A publication from
the academy of medicine, in which they declared the seeds
of the disease to spread from the atmosphere only, produ-
ced a sudden flight of the inhabitants.  In no year, since
the prevalence of the fever, was the desertion of the city
so general.
   I shall now add a short account of  the symptoms and
treatment of this epidemic.
   The arterial system was in most cases  active. I met
with a tense pulse in a patient after the appearance of the
black vomiting.   Delirium was less  frequent in adults
than in former years. In children there was a great deter-
mination of the disease to the brain.
   I observed no new symptoms in the stomach and bow-
els.  One of the worst cases of the fever which I saw was
accompanied with cholic. A girl of Thomas Shortell, who
recovered, discharged nine worms during her fever.   It
appeared in Mr. Thomas Roane, one of my pupils, in  the
form of a dysentery.
   A stiffness, such as follows death, occurred in several
patients in the city hospital before death.
   Miss Shortall had an irruption of pimples on her breast,
such as  I have described in a short account I gave of the
yellow fever of 1762 in this city, in my account of  the
disease in 1793.
   The blood exhibited its usual appearances in the yellow
fever.   It was seldom sizy till towards the close of  the
disease.
   The tongue was generally whitish.  Sometimes it was
of a red colour, and had a polished appearance.  I saw
no case  of a black tongue, and but few that were yellow
before the seventh day of the disease.
   The type of this disease was nearly the same as describ-
ed in 1797.  It now and then appeared in the form of a
quartan, in which state it generally proved fatal. It appear-
ed with rheumatic pains in one of my patients. It blended
itself with gout and  small-pox.  Its union with  the latter
disease was evident in two patients in  the city hospital, 'in
each of whom the stools were such as  were discharged in
the most malignant state of the fever.
   vol. iv.                 H 
58
AN  ACCOUNT OF THE
   The remedies for this fever were bleeding, vomits, pur-
ges, sweats, and a salivation and blisters.
   There were few cases that did not indicate bleeding. It
was performed, when proper, in the usual way, and with
its usual good effects. It was indicated as much when the
disease appeared  in the bowels  as in the blood-vessels.
Mr. Roane, in whom it was accompanied with symptoms
of dysentery, lost nearly 200 ounces of blood by twenty-
two bleedings.
   I found the same  benefit from emetics, in this fever,
that I  did in the fever of 1798. They were never admin-
istered except on the  first day,  before violent action had
taken place in the system, or after it was moderated by
one or two bleedings.
   Purges of calomel and jalap, also castor oil,  salts, and
injections, were prescribed with their usual advantages.
   In those cases where the system was prostrated below
the  point of re-action,  I began  the  cure by  sweating.
Blankets, with hot bricks wetted with vinegar, and the hot
bath, as mentioned formerly, when practicable, were used
for this purpose.  The  latter produced,  in a boy of 14
yrears of age, who  came  into the city hospital without a
pulse, and with a cold  skin, in  a few hours,  a  general
warmth and an active pulse.   The determination of the
disease to the  pores was evinced in one of my patients, by
her sweating under the use of the  above-mentioned reme-
dies, for the first time in her life.  A moisture upon her
skin had  never before been induced, she informed  me,
even by the warmest day in summer.
   The advantages of a salivation were as great as in for-
mer years. From the efficacy of bleeding, purges, emetics,
and sweating, I had the pleasure of seeing many recoveries
before the mercury had time to affect the mouth.  In no
one case did I rest the cure exclusively upon any one of
these remedies.  The more numerous the outlets were to
convey oft* superfluous fluids and excitement  from the
body,  the more safe and certain were the recoveries.  A
vein, the gall-bladder, the bowels, the pores, and the sali-
vary glands, were all opened, in succession, in part, or to-
.gether,according to circumstances, so as to give the disease
every possible chance of passing out of the body without
injuring or destroying any of its vital parts. 
BILIOUS YELLOW FEVER OF 1799.        59
   Blisters were applied with advantage.  The vom't^ng
 and sickness which attend this  fever were relieved  iii
 many instances, by a blister to the stomach.
   In those cases in which the fever was protracted to the
 chronic state, bark, wine, laudanum, and rei her produced
 the most salutary effects.  I  think  I saw life recalled, in
 several cases in which it appeared to be departing bv fre-
 quent and liberal doses of the last of those medicines/ The
 bark was given, with safety and advantage, after the seventh
 day, when  the fever assumed the form of an intermittent.
   The following symptoms were generally favourable, viz.
 a bleeding from the mouth and gums, and a disposition
 to weep, when spoken to in any stage of the fever.
   A hoarseness and sore throat indicated a fatal issue of
 the disease, as it did in 1798.  Dr. Physick remarked, that
 all those persons who sighed after waking suddenly, be-
 fore they were  able to speak, died.
   The recurrence of a redness of the eyes, after it had
 disappeared, or of but one eye, was generally followed by
 death. I saw but one recovery with a red face.
   I saw several persons, a few hours before death, in whom
 the countenance, tongue, voice, and pulse were perfectly
 natural. They complained of no pain, and discovered no
 distress nor solicitude of mind.   Their danger was only
 to be  known by the circumstances which had preceded
 this apparently healthy and tranquil state of the system.
 They had all  passed through extreme suffering, and some
 of them had puked black matter.
   The success of the mode of practice I have describee!
 was the same as in former years, in private families;  but
 in the city hospital, which was again placed under the care
 of Dr. Physick and myself, there was a very different
 issue to it,  from causes which are too obvious to be men-
 tioned.
  There were two opinions given to the public upon the
 subject of the origin of this fever; the one by the a< ademy
 of medicine, the other by the college of physicians.  The
former declared it to be generated in the city, from putrid
domestic exhalations, because they saw it only in their
vicinity, and discovered no channel by which it could have
been derived from a foreign country; the litter asserted it
to be " imported, because it had been imported in former
years." 
 
ACCOUNT OF SPORADIC CASES




             OF





     YELLOW FEVER,





           AS THEY




   APPEARED IN PHILADELPHIA,




           IN 1800. 
 
AN ACCOUNT, &c.
     THE weather in the month of January was less cold
 than is common in that month. Catarrhs, the cynanche
 trachealis, and bilious pleurisies, were prevalent in every
 part of it. A few cases of yellow fever occurred likewise
 during this month.
   Several cases of erysipelas appeared in February.
   The month of March was unusually healthy.
   The weather was warm in April, and the city as healthy
 as in March.
   It was equally so in May and June. The spring fruits
 appeared early in the  latter month, in large quantities, and
 were of an excellent quality.  Locusts were universal in
 June.  They had not appeared since the year 1783.  A
 record from the journal of the Swedish missionaries was
 published at this time, which described  their appearance
 in 1715, in which year it was said to  be very healthy.
   On  the 14th of June there was a severe thunder gust
 with more lghtning than had been known for seven years
 before.
  There fell, during  all the months that have been men-
 tioned, frequent and plentiful showers of rain, which ren-
 dered the crops of grass luxuriant in the neighbourhood
 of Philadelphia.
  The winds  at this time were chiefly from the south-
east.
  A few intermittents appeared in June, which yielded
readily to the bark.
  On the 16th day of June, Dr. Physick informed me he
had a black boy under his care with the yellow fever.
  In July, the hooping cough, cholera  infantum, and 
 64       AN ACCOUNT OF SPORADIC CASES

 some cases of dysentery and bilious fever appeared in the
 city.
    On the 30th of July, Dr. Pascalis informed me that he
 had lost a patient on the fifth day of a yellow fever.
    In August, the  dysentery  was the principal form of
 disease that prevailed in the city.
    On the 23d of this month a woman died of the  yellow
 fever in Gaskill-street, under the care of Dr. Church.
    On ihe 28th and 30th, there fell an unusual quantity of
 rain. The winds were south-west and north-west  during
 the greatest part of the summer months.  The latter was
 sometimes accompanied with rain.
    On the 11th of September, a clerk of Mr. Levi Hol-
 lingsworth, and, on the 12th, a  clerk of Mr. John Con-
 nelly, died with  the yellow fever.
    A plentiful shower of rain  fell on the night of the 21st
 of this month.
    About this time there appeared one and twenty cases of
 yellow fever in Spruce-street, between Front and Second-
 streets.  They were all in the neighbourhood of putrid ex-
 halations.  Fourteen  of them ended fatally.
    No one of the above cases of malignant fever could be
 traced to a ship,  or to a direct or indirect intercourse with
 persons affected  with that disease.
    While Philadelphia was thus visited by a few sporadic
 cases only of yellow fever, it was epidemic in several of
 the cities of the United States, particularly in New-York,
 Providence, in Rhode Island, Norfolk, and Baltimore  In
 the last named place, it was publicly declared by a com-
 mittee of health  to be of domestic origin.
    The dysentery7 was epidemic, at the same time, in se-
, veral of the towns of Massachusetts and New-Hampshire.
 It was attended with uncommon mortality at Hanover, in
 the latter state.
    This difference in the states of health and sickness in the
 different parts of the United  States, must  be sought for
 chiefly in the  different states of the weather in those  places.
 The exemption  of Philadelphia from the yellow fever, as
 an epidemic,  may perhaps be ascribed to the strength and
 vigour of the vegetable products of the year, which retar-
 ded their putrefaction; to frequent showers of rain, which 
OF YELLOW FEVER IN 1800.
65
washed away the filth of the streets and gutters; and to
the perfection of the summer and autumnal fruits.
  The months of November and December  this year
were uncommonly healthy.   During the former, several
light shocks of earthquakes were felt in  Lancaster and
Harrisburgh, in Pennsylvania, and in Wilmington, in the
state of Delaware.
vol. iv. 
 
             AN





ACCOUNT OF SPORADIC CASES




             OF





     YELLOW FEVER,





           AS THEY





   APPEARED IN PHILADELPHIA,




           m 1801. 
 
AN ACCOUNT,  &c.
     THE month of January was intensely cold.  In Fe-
bruary it became more moderate.  The diseases, during
these two months, were catarrhs and a few pleurisies.
   In March and April there fell an unusual quantity of
rain.   I he hay harvest began in the neighbourhood of
Philadelphia  on the 28th of May.   A few mild cases of
scarlatina anginosa occurred during these  months.
   In June the weather was dry and healthy.
   On the  8th of J  ly, a case of yellow fever occurred in
the practice of Dr  Stewart.  About the  15th of the
month, a patient died with it in the Pennsylvania hospital.
Dr. Physick informed me  that he hady at the same time,
two patients under his care with that disease.  Several
cases of the measles  appeared in the south end of the
city  during this month. In every part of it, the weather
was  warm and dry, in consequence of which there were
no second crops of grass, and  a smaller quantity than
usual of summer fruits and vegetables. The winds were
less steady than they had  been for seven years.  They
blew, every two or three  days, from  nearly every point
of the compass.
  On the 4th of August there fell a considerable quantity
of rain, which was succeeded by cool  and pleasant wea-
ther. The cholera morbus  was a  frequent disease among
both adtilts and children in the city, and the dysentery in
several of the adjoining counties of the state.
  A number of emigrant families arrived this month from
Ireland  and Wales, who   brought  with  them the ship
fever. They were carefully attended, at the lazaretto and
the city hospital, in airy rooms, by which means they did
not propagate the disease.   Contrary to its usual charac-
ter, it partook of the remissions of the bilious fever, pro-
bably from the influence of the season  upon it.
   In September there were a  few extremely warm days.
In the beginning and middle of the month a number of 
 70     AN ACCOUNT OF SPORADIC CASES, &Cl

 mild remittents occurred, and about the 22d there  were
 five or six cases of yellow fever in Eighth-street, between
 Chesnut and Walnut-streets, in two houses ill ventilated
 and exposed to a good deal of exhalation. I attended most
 of these cases in consultation with Dr. Gallaher. One of the
 persons who was affected with this fever puked black mat-
 ter while I sat by his bed-side, a few hours before he died.
   During the summer and autumn of this year, a number
 of cases of yellow fever appeared at New-Bedford, Port-
 land, and Norwich, in the New-England states; in New-
 York; in some parts of New-Jersey; and in Northampton
 and  Bucks counties, in Pennsylvania. It prevailed so ge-
 nerally in New-York, as  to produce a considerable deser-
 tion  of the city.  In none of the above  places  could the
 least proof be adduced of the disease being imported.  In
 Philadelphia its existence was doubted or denied by most
 of the citizens, because  it appeared  in situations remote
 from the water, and of course could not be derived from
 any foreign source.
   It will be difficult to tell why the fever appeared only in
 sporadic cases in Philadelphia. Perhaps its prevalence as,
 an epidemic was prevented by the plentiful  rains in the
 spring months, by the absence of moisture from the filth of
 the streets and gutters, in consequence of the dry weather
 in June and July, by the vigour and perfection of the pro-
 ducts of the earth, and by the variable state of the winds in
 the month of July.   If none of these causes defended the
 city from more numerous cases of the yellow fever, it must
 be resolved into the want of a concurring  inflammatory
 constitution of the atmosphere with the common impure
 sources of that disease.
   On the 12th of November, about twelve o'clock in the
night, an earthquake was felt in Philadelphia,attended with
 a noise as if something heavy had fallen upon a floor.  Se-
 veral cases of scarlet fever appeared in December, but the-
 prevailing disease,  during the two last autumnal and the
first  winter months, was the measles. I have taken notice
 that  it appeared in  the south end of the city in July. Dur-
 ing the months of August and September it was stationary,'
but in October,November and December it spread through
every part of the city. The following circumstances occur-
 red in this epidemic, as far as. it came under may notice. 
      AN ACCOUNT





            OF






  THE MEASLES,





          AS THET





APPEARED IN PHILADELPHIA,




      IN THE YEAR 1801. 
 
AN ACCOUNT, &c.
     I.  THE disease wore the livery of the autumnal
fever in the following particulars.
  It was strongly marked by  remissions and intermis-
sions.  The exacerbations came on chiefly at night.
  There were in many cases a constant nausea, and dis-
charge of bile by puking.
  I saw one case in which the disease appeared with a
violent cholera morbus, and several  in which it was ac-
companied with diarrhoea and dysentery.
  II. Many  severe cases of phrenzy, and  two of cy-
nanche trachealis appeared with the  measles.
  III. A distressing sore mouth followed them, in a child
of two years old, that came under my care.
  IV.  A fatal hydrocephalus internus followed them in
a boy of eight years old,  whom  I saw two days before he
died.
  V. I met with a  few cases  in which  the fever and
eruption  came on in the same day,  but I saw one case
in which the eruption did  not take place until the tenth,
and another, in which it did not appear until the  four-
teenth day after the fever.
  VI.  Two children  had pustules  on  their skins, re-
sembling  the  small-pox,  before  the eruption  of the
measles.
  VII. Many  children had coughs and watery eyes, but
without the measles.   The same children had them two
or three weeks afterwards.
  VIII.  Many people  who  had had the  measles, had
coughs during the prevalence of the measles, resembling
the cough which occurs in that disease.
  The remedies made use  of in my practice were,
  1. Bleeding, from four to sixty ounces, according to
the age of the patient,  and  the state of the pulse.   This
  VOL. IV.                K 
74            AN ACCOUNT OF THE, &C
remedy relieved the cough, eased the pains in the head,
and in one case produced, when  used a  third time,  an
im.nedtate eruption of the measles.
  2.  Lenient purges.
  3.  Demulcent drinks.
  4.  Opiates at night.
  5   Blisters.    And,
  6.  Astringent medicines where a diarrhcea took place.
  I  saw  evident advantages  from advising a  vegetable
diet to many children, as soon as  any  one of the families
to which they belonged were attacked by the measles.
  I  lost but one patient in this disease,  and that was a
child in convulsions.  I ascribed  my success to bleeding
more generally  and more copiously than I had  been ac-
customed to do in the measles of former years. 
       AN ACCOUNT




           OF THE





BILIOUS YELLOW FEVER,




           AS IT




  APPEARED IN PHILADELPHIA,




       IN THE YEAH 1802. 
 
AN ACCOUNT, &c.
  THE weather during the month of January was un-
usually moderate and pleasant.  In the latter end of it,
muny shrubs put forth leaves and blossomed.  I saw a
leaf of the honeysuckle, which was more than an inch in
length, and above half an inch in breadth.  There  was
but one fall of snow, and  that a light one, during the
whole month.
  The winds blew chiefly from the south-west in Feb-
ruary.  There was a light fall of snow on the 6th.  A
shad was caught in the Delaware, near the city, on the
17th.   On the 18th and 19th of the month,  the weather
became suddenly  very  cold.  On the 22d there was a
snow  storm, and on the 28th, rain  and a general thaw.
  In March, the weather was wet, cold, and stormy, with
the exception of a few pleasant days.
  The scarlatina  anginosa  and the cynanche trachealis
were the principal diseases that prevailed during the three
months that have been mentioned.
  In  April,  there  were several frosts, which destroyed
the blossoms of the peach-trees.
   In May, the weather was so cool as to make firesagree-
able to the last day of the month.  The wind blew chief-
ly, during the whole of it, from the  north-east.
  The scarlatina continued  to be the reigning disease.  I
saw one fatal case of it, in which a redness only, without
any ulcers or sloughs, appeared in the throat; and I attend-
ed another, in which a total immobility in the limbs was
substituted by nature for the pain and swellings in those
parts which generally  attend the disease.  There were
three distinct grades of this epidemic.  It was attended
with such inflammatory or malignant symptoms, in some 
78
AN ACCOUNT OF THE
  instances,  as to require two or three bleedings; in others
  it appeared with a typhoid pulse, which yielded to emetics:
  turbith mineral was preferred for this  purpose;  while a
  redness, without a fever, which yielded to a single purge,
 • was the only symptom of it in many people.
    The weather was cool,  rainy, and  hot, in  succession,
  in the  month of June.  The scarlatina continued to be
 the prevailing disease.
   During the first and  second weeks in July, there fell
 a good deal of rain,   On the  4th of the  month  I  was
 called to visit Mrs. Harris, in Front-street, between Arch
 and Market-streets, with a bilious fever.   The scarlatina
 had imparted to it a general  redness on her skin, which
 induced her to believe it was that disease, and to neglect
 sending for medical relief  for several days,   hhe died on
 the  13th of the month, with a red eye, a  black tongue,
 hiccup, and a yellow skin.  Three other cases of malig-
 nant bilious fever occurred this month.  Two of them
 were attended by Dr. Dewees and Dr. Otto.
   On the 15th of the month, the city was alarmed by an
 account of this fever having appeared near the corners of
 Front and Vine-streets,  a  part of the city which had for
 many weeks before been complained of by  many  people
 for emitting a foetid smell, derived from a great quantity
 of filthy matters stagnating in  that neighbourhood, and
 from the foul air discharged from a vessel called the Es-
 peranza, which lay at Vine-street wharf.
   On the 2d of August, it appeared in other parts of the
 city,  particularly in Front  and Water-streets, near the
 drawbridge, where it evidently originated  from  putrid
 sources.  Reports were  circulated that  it was derived
 from contagion, conveyed to Vine* street wharf in the tim-
 bers of a vessel called the St, Domingo Packet, but faith-
 ful and  , accurate  inquiries proved  that  this  vessel had
 been detained one and twenty days, and  well cleaned at
 the lazaretto, and that no one,  of fourteen men who had
 worked on board of her afterwards, had been affected with
 sickness of any kind.
   On the 5th of August,  the  board of health publicly
declared the fever to be cantagious, and advised an  imme-
diate desertion of the city.   The advice was followed with
uncommon  degrees of terror and precipitation. 
          BILIOUS YELLOW FEVER OF 1802.       79

  The disease continued, in different parts of  the  city,
during the whole of August and  September.   On the
5th of October, the citizens were publicly invited from
the co mtn by the board of health.
  During this season, the yellow fever was epidemic in
Baltimore and Wilmington.   In the former place it was
admitted by their board of health, and in the latter it was
proved by  Dr. Vaughan, to be of  domestic origin.  It
prevailed, at the same time,  in  Sussex county and near
Woodbury, in New Jersey. Sporadic cases of it likewise
occurred in New-York and Boston, and in  Portsmouth,
in New-Hampshire.  The chronic fever, was epidemic
in several of the towns of North-Carolina;  cases of fever,
which terminated in swelling and mortification of the
legs, and  in death on the third day, appeared on the wa-
ters of the Juniata, in Pennsylvania;  and bilious fevers, of
a highly inflammatory grade, were likewise common near
Germantown  and Frankford,  in the neighbourhood of
Philadelphia.
  But few of the cases of yellow fever which have been
mentioned came under my care, but 1 saw a considera-
ble  number of fevers of a less violent grade.   They were
the  inflammatory, bilious, mild remitting, chronic, and
intermitting fevers, and the febricula.  They appeared,
in some instances,  distinct from each other, but  they
generally blended their symptoms in their different stages.
The yellow fever often came on in the mild form of an
intermittent, and even  a  febricula, and as often, after a
single paroxysm, ended in a mild remittent or chronic
fever.   When it appeared in the latter form, it  was fre-
quently  attended with a slow or low pulse,  and a vomi-
ting and hiccup, such as attended in the yellow fever.
This diversity of symptoms, with which the summer and
autumnal'fever came on, made  it impossible to decide
upon its type on the day of its attack.  Having been de-
ceived in one instance, I made it a practice afterwards to
watch every case I was called  to with double vigilance,
lest it should contract a  malignant form in my hands,
without  my being prepared to meet it.  Of the five ori-
ginal  and obvious cases of yellow fever to which I was
called, I saved none, for I saw but one  of them before 
80           AN ACCOUNT OF THE, &C.
the last stage of the disease.   In many others I have
reason to believe I prevented that  malignant form of fe-
ver, by the early and liberal use  of depleting medicines.
The practice of those physicians  who attended most of
the persons who had the yellow fever, was much less suc-
cessful than  in our former epidemics.  I suspected at the
time, and I  was convinced afterwards, that it was occa-
sioned by relying  exclusively upon bleeding, purges, and
mercury. The skin, in several of the cases which I saw, was
covered with moisture. This clearly pointed out nature's
attempt to relieve herself by sweating.  Upon my men-
tioning this  fact to the late Dr. Pfeifter, jun. he instantly
adopted my opinion, and informed me,  as a reason for
doing so,  that he had heard of several whole families in
the Northern Liberties, where the disease prevailed most,
who, by attacking it in  its  forming state by profuse
sweats, had cured themselves,  without the advice  of a
physician. 
       AN ACCOUNT


           OF THE


BILIOUS YELLOW FEVER,

                          i
            AS IT


  APPEARED IN PHILADELPHIA,


        IN THE TEAR 1803.
VOL. IV.
L 
 
AN ACCOUNT,  &c
     THE weather in January was uniformly cold.  On
the 21st of the month, the  Delaware was completely
frozen.
   On the 4th of February there was  a general thaw, at-
tended with a storm of hail, thunder, and lightning, which
lasted about three quarters of an hour.  The diseases of
both these winter months were catarrhs and bilious pleu-
risies.   The latter appeared in a tertian type.   The paift
in the side  was most sensible every other day.
   The weather was cold and dry in March, in conse-
quence of which vegetation was unusually backward in
April.  The hooping cough, catarrhs  and scarlatina were
the diseases of this month.
   The beginning of May was very cool.  There was ice
on the 7th of the month.  The winds during the greatest
parts of this and the previous month, were from the north-
east.
   In June, the weather was cool. Intermittents were com-
mon in this month, as well as in May. Such was the pre-
dominance  of this  type  of  fever over all other diseases,
that it appeared in the form of profuse sweats, every other
night, in a lady under the care of Dr. Dewees and myTself,
in the puerperile, without the least moisture on her skin.
There were a few choleras this month. During the latter
end of the month, I lost a patient with many of the symp-
toms of yellow fever.
   The weather in July was alternately hot, moderate, and
cool, with but little rain.   The first  two  weeks  of  this
month were healthy. A few tertian fevers occurred, which
readily yielded to bark,  without previous  bleeding.   Be-
tween the 25th and 31st of the month, three deaths  took      ^-
place from the yellow fever. 
84
AN ACCOUNT OF THE
  In the month of August, the weather was the same as in
July, except that there fell more rain in it. Mild remittents
and cholera infantum were now common.  There  were
likewise several cases of yellow fever during this month.
One of them was in Fromberger's-court.  It was induced
by the fcetor of putrid fish in a cellar. A malignant dysen-
tery was epidemic during this month in the  upper part of
Germantown, and in its neighbourhood. Several persons,
Dr. Bensell informed me, died of it in thirty hours'  sick-
ness.  It prevailed, at the same time, in many parts of the
New-England states.
  Jn September, cases of yellow fever appeared in differ-
ent parts of the city, but chiefly in Water near Walnut-
street. On the 12th of the month, the board of health pub-
lished a declaration of its existence  in the city, but said it
was not contagious.  This opinion gave great offence, for
it was generally said to have been imported by means of
a packet boat from New-York, where the fever then pre-
vailed, because a man had sickened and died in the neigh-
bourhood of the wharf where this packet was moored. It
was to no purpose to oppose to this belief, proofs that no
sick:lperson, and no goods supposed to be infected, had
arrived  in this  boat, and that no one of three men, who
had received the seeds of the disease in New-York, had
communicated  it  to any one of  the families in Philadel-
phia, in which they  had sickened and died.
  The disease assumed a new character this year, and was
cured by a different force of medicine from that which was
employed in some of the years in which it had prevailed
in Philadelphia.
  I shall  briefly describe it in each of the  systems, and
then take notice of some peculiarities which attended it.
Afterwards I shall mention the remedies which  were ef-
fectual in curing it.
   1. The pulse was moderately tense in most cases. It
intermitted in one case, and in several others the tension
was of a transient nature.
  Haemorrhages occurred  in many cases.   They were
chiefly from the nose, but in some instances they occurred
from the stomach, bowels, and hemorrhoidal vessels.
  2. Great flattulency attended in the stomach, but  sick-
ness and vomiting were much less frequent than in former 
BILIOUS YELLOW FEVER OF 1803.       58
years. I saw but one case in which diarrhoea attended this
fever.
  3. I did not meet with a single instance of a glandular
swelling in any part of the body.
  4. There was a general disposition to sweat in this fever
from its beginning.  Two of my patients died, in whom
no moisture could be excited on the skin.  But I recovered
one with a  dry skin,  by means of a purge, two bleedings,
and blisters.
  An efflorescence on the skin occurred in several instan-
ces.  1 saw black matter discharged from a blister in one
case, and blood in another.
  5. The stools were green and black. Bile was general-
ly discharged in puking.
  6. The blood exhibited the following appearances: sizi-
ness, lotura carnium, sunken crassamentum, red sediment,
and what is called dense or unseparated blood.  I saw no
instance of its being dissolved.
  7. The  tongue was whitish and dark-coloured.   This
diseased appearance continued, in some instances, several
days after a recovery took place.   I saw no  smooth, red,
nor black tongue, and but one dry and one natural tongue.
The latter  was followed by death.
   I did not see a single case in which the disease  came on
without an exciting cause;  such as light clothing and bed-
clothes, sitting at doors after night, a long walk, gunning,
and violent and unusual  exercises of any kind.  It was
excited in a number of people by their exertions to ex-
tinguish a fire which took place in Water-street,  between
Market and Chesnut-streets,  on the morning of  the 25th
of August.  I  saw a fatal instance of it succeed a severe
tooth-ach.  Whether this pain was the exciting cause, or
the first morbid symptom of the fever, I know not;  but I
was led  by it to bleed a young lady twice who complain-
ed  of that pain, and who  had at the  same time a  tense
pulse.  Her blood had the usual appearances which occur
in the yellow fever.
   The disease had different appearances  in different parts
of the city.  It was most malignant in Water-street; but
in many instances it became  less so, as it travelled west-
ward, so that about Ninth-street it appeared in the  form
of a common intermittent. 
86
AN ACCOUNT OF THE
      In every part of the city it often came on, as in the year
    1802, in all the milder forms of autumnal fever formerly
    enumerated, and went off with all the usual symptoms of
    yellow fever.   Again, it came on with all the force and
    malignity of a yellow fever, and terminated, in a day or
    two, in a common remittent or intermittent. These modes
    of attack were so common, that it  was impossible to tell
    what the character, or probable issue of a fever would be,
    for two or three days.
      The following remedies were found, very generally, to
    be effectual in this fever.
      1.  Moderate bleeding.  I bhd but three patients three,
*   and only one four times.  In general, the loss of from ten
    to twenty ounces of blood, reduced the pulse from a sy-
    nocha to a synoichoid or typhoid state, and thereby pre-
    pared the system for other remedies.
      2.  Purges were  always useful.   I gave calomel and
   jalap, castor oil, salts, and senna,  according to the grade
    of the disease, and often according to the humour or taste
    of the patient.  I  aided these purges by glysters.  In one
    case, where a griping and black stools attended, I directed
    injections of lime-water and milk to be used with the hap-
    piest effects.
      3.  I gave emetics  in many cases with advantage, but
   never while the pulse was full or tense.
      4. Having observed, as in the year 1802, a spontaneous
   moisture on the skin on the first day of the disease, in se-
   veral cases, I was led to assist this disposition in nature to
   be relieved by the pores, by means of sweating remedies,
   but in no instance did I follow it, without previous evacu-
   ations from the blood-vessels or bowels;  for, however use-
   ful the intimations of nature may be in acute diseases, her
   efforts should never be trusted to alone,  inasmuch as they
   are in most cases too feeble to  do service, or so violent as
   to do mischief. I saw one death, and I heard of another,
   from an exclusive reliance  upon spontaneous sweats in
   the beginning of this  fever.  The remedies I  employed
   to promote this evacuation  by the pores were, an infu-
   sion of the  eupatorium perfoliatum in boiling water, aid-
   ed by copious warm drinks, and  hot  bricks and blan-
   kets, applied to the external surface of the body.   The
   eupatorium sometimes sickened the stomach, and puked. 
BILIOUS YELLOW FEVER OF 1803.       87
The sweats were intermitted, and renewed two or three
times in the course of four and twenty hours.
  5. I derived great advantage  from the  application  of
blisters to the wrists, before the system descended to what
I have elsewhere called the blistering point.  This was on
the second and third days.  My design, in applying them
thus early,  was to attract morbid excitement to the extre-
mities, and thereby to create a substitute  for salivation.
They had this effect.   The pain, increase of fever, and
occasional strangury, which were produced by them, serv-
ed like anchors to prevent the system being drifted and
lost, by the concentration of morbid excitement  in the
stomach and brain, on the fourth, fifth, sixth, and seventh
days of the disease.   It gave me great pleasure to find,
upon revising Dr. Home's account of the yellow fever,
that this mode  of applying blisters, in the early stage of
the disease, was not a  new one.   He often applied them
in the  first stage of the fever, more  especially when the
yellow colour of the skin made its appearance on the first
or second day.  By the advice of Dr. Cheney of Jamaica,
he was led to prefer  them to  the thighs,  instead of the
trunk of the body, or the legs and arms.  He forbids their
ever being applied below the calf of the legs.   This cau-
tion  is probably more necessary in the West-Indies than
in the United States.   The pain and inflammation excited
by the blisters were mitigated by soft poultices of bread
and  milk.   The strangury soon  yielded  to demulcent
drinks, particularly to flaxseed tea.
  I was happy in not  being compelled, by the violence
or obstinacy of this fever, to resort to a salivation in or-
der to cure  it,  in a single instance; the discharges from
the stomach and bowels, and  from the veins, pores, and
skin, have  proved sufficient to convey the disease out of
the system.
   Two persons  recovered this  year who had the black
vomiting.   One of them was by means of large quanti-
ties of brandy  and volatile alkali,  administered by Dr.
John Dorsey, in the city hospital; the other was by means
of lime and water and milk, given by an intelligent nurse
to one of my patients, during the interval of my visits to
her.
  From the history which has been given of the  symp- 
88           AN ACCOUNT OF THE, &C.
toms of this fever; from the less force of medicine that
was necessary to subdue it; from the safety and advantage
of blisters in its early stage; and from the small proportion
which the deaths bore to the number of  those who were
affected, being  seldom more than five in a hundred
(including all the grades and forms of the disease,) in the
practice of most of the physicians, it is evident this fever
was of a less malignant nature than it had been in most
of the years in which it had been epidemic.  There was
one more circumstance which proved its diminution of
violence, and that was, a more feeble operation of its re-
mote cause.  In the year 1802, nearly all the persons who
were affected with the fever in the neighbourhood of Vine
and Water-streets, and in Water, between Walnut and
Spruce-streets, died.  This year, but two died of a great
number who were sick in the former, and not one out of
twelve who were 6ick in the latter place.   The filth, in
both parts of the  city, was the same in both years.   This
difference in the  violence and mortality of the fever was
probably occasioned by a less concentrated state of the
miasmata which  produced it, or by  the co-operation of a
less inflammatory constitution of the atmosphere.
  The yellow fever was epidemic,  during  the  summer
and autumn of  this  year, in New-York, and in  Alexan-
dria, in Virginia.  In the latter place, Dr. Dick had in-
formed the public, it was derived from domestic putrefac-
tion. 
ACCOUNT OF SPORADIC CASES









     YELLOW FEVER,





           AS THEY




   APPEARED IN PHILADELPHIA,



           IN 1804.
VOL. IV.
* >I 
 
AN ACCOUNT, &c.
    THE month of January was marked by deep snows,
rain, clear and cold weather, and by the general healthi-
ness of the city.
  In February there fell a deep snow, which was follow-
ed by  several very cold days.  There  was likewise a fall
of snow in March, which was  succeeded by an uncom-
mon degree of cold. Catarrhs and bilious pleurisies were
very common during both these months.
  In the  beginning of April, the weather was cold and
rainy.  There were but few signs of vegetation before the
15th of the month. Bilious pleurisies  were still the prin-
cipal diseases which prevailed in the city.
  The month of May was wet, cool, and healthy.
  In June, the winds were easterly, and the weather rainy.
The crops of grass were luxuriant.  It was remarked,
that the milk  of cows that fed upon  this grass  yielded
less butter than  usual, and that horses that fed upon it,
sweated profusely with but little exercise.   On the third
of the month, I was  called  upon by Dr. Physick to
visit his father, who  was ill with a bilious fever.  He
died on the seventh, with a red eye, hiccup,  and black
vomiting.
  Four persons had the yellow fever in the month of July.
One of them was  in  Fourth-street, between Pine and
Lombard-streets, another was in  Fifth-street,  between
Race and Vine-streets, both of  whom recovered.  The
remaining two were in the Pennsylvania hospital, both of
whom died.  Remitting and intermitting fevers were like-
wise common in  this  month.
  In August, those fevers assumed a chronic form. Dur-
ing this month, there died an unusual number of children
with the cholera morbus.
  The city was uncommonly healthy  in September.  A 
 92     AN ACCOUNT OF  SPORADIC CASES, &C.

 storm of wind and rain, from the south east, proved de-
 structive to the crops of cotton this month, on the sea
 coast of South-Carolina.
   In October, intermittents were very common between
 Eighth-street and Schuylkill.  One case of yellow fever
 came under my care, in  conjunction with  Dr. Gallaher,
 on the western banks of that river.
   While  Philadelphia and  all  the  cities of the United
 States (Charleston excepted) were thus  exempted from
 the yellow fever as an epidemic, the western parts of all
 the middle, and several of the southern states, were visited
 with the bilious  fever, in all its different forms. In Dela-
 ware county, in  the state of New York,  at Mill river, in
 Connecticut, and in several of the middle counties of
 Pennsylvania, it prevailed in the form of a yellow fever.
In other parts of the United States,  it appeared chiefly as
a highly inflammatory remittent.  It was so general, that
not only whole families, but whole neighbourhoods were
confined by it.   Many suffered from the want  of medical
advice and nursing, and  some  from the want  of even a
single attendant. In consequence  of  the general preva-
lence of this fever  in  some parts of  Pennsylvania, the
usual labours of the season  were suspended.  Apples fell
and perished upon the ground;  no winter grain was sow-
ed; and  even cows passed  whole days and nights without
being milked.
   The  mortality of this  fever  was considerable, where
those distressing circumstances took place. In more fa-
 vourable circumstances, it yielded to early  depletion, and
afterwards to the bark.  Relapses were frequent from pre-
 mature  exposure to the air.  Those only escaped them
who had  been salivated,  by accident  or design, for the
 cure of the fever.
   This disease  was  observed  very generally to prevail
 most in high situations, which  had  for years been distin-
 guished for their healthiness, while the low grounds, and
 the banks of creeks and rivers,  were but little affected by
 it. The unusual quantity of rain, which had fallen during
 the summer months, had produced moisture in  the former
 places, which favoured putrefaction and exhalation, while
 both were prevented, in the latter places^ by the grounds
 being completely covered wi^th  water. 
      AN ACCOUNT





           OF THE






BILIOUS YELLOW FEVER,






            AS IT





  APPEARED IN PHILADELPHIA,





        IN THE TEAB 1805. 
/
'\ 
AN ACCOUNT,  &c.
    FOR a history of the uncommonly cold and tempes-
tuous winter of 1804 and 1805, the reader is referred to
the Account of the Climate of Pennsylvania, in the first
volume of these Inquiries and Observations.
  During the months of January, February, and March,
there were a number of bilious catarrhs and pleurisies.
  On the 7th of April, I visited a patient in the yellow
fever with Dr. Steuart. He was cured, chiefly by copious
bleeding.
  The weather was rainy in May.  After the middle of
June, and during the whole month of July, there fell no
rain. The mercury in Fahrenheit fluctuated, for ten days,
between 90° and 94°, during this month.  The diseases
which occurred in it were cholera  infantum, dysenteries,
a few common bilious, and eight cases of yellow fever.
Three of the last were in Twelfth, between Locust and
Walnut-streets, and were first  visited, on the 14th and
15th of the month, by Dr. Hartshorn,  as out-patients of
the Pennsylvania hospital.  Two of them were attended,
about a week afterwards, by Dr. Church, in Southwark,
and the remaining three by Dr. Rouisseau and Dr. Steu-
art,  in the south end of the city.
  On the 3d of August there fell a heavy shower of rain,
but the weather, during the remaining part of the month,
was warm and dry.  The  pastures were burnt  up,  and
there was a great deficiency of summer vegetables in the
neighbourhood of Philadelphia.  The water in the Schuyl-
kill  was lower by three inches than it had been  in the
memory of a man of seventy years of age, who had lived
constantly within sight of it.
  In September, a number of cases of yellow fever ap- 
96              AN ACCOUNT OF  THE
 peared in Southwark,* near Catharine-street. They were
 readily traced to a large bed of oysters, which had putre-
 fied on Catharine-street wharf, and which had  emitted a
 most  offensive exhalation  throughout the whole neigh-
 bourhood, for several weeks before the fever made its ap-
 pearance.  This exhalation proved fatal  to  a number of
 cats and  dogs, and  it now became  obvious  that the two
 cases  of yellow fever, that were attended by Dr. Church,
 in the month of July, were derived from it.   An attempt
 was made to impose a belief that they were taken by con-
 tagion from a ship at the lazaretto, which had lately arri-
 ved from the West-Indies; but a careful investigation of
 this tale  proved, that neither of the two subjects of the
 fever had been on  board that, nor any other ship, then
 under quarantine.
   The fever prevailed during the whole of this  month in
 Southwark.  A few cases of it appeared in the city, most
 of which were in persons who had resided in, or visited
 that district. It was brought on by weak exciting causes
 in Southwark, but the cases which originated in the city,
 required strong exciting causes to produce them.
   A heavy,rain,  accompanied with a good deal  of wind,
 on the 28th of September, and a frost on the night of the
 7th of October, gave a considerable check to the fever.
   But few cases of it came under my care.   Having per-
 ceived the same disposition in nature to relieve herself by
 the pores, that I observed in the years 1802 and 1803, my
 remedies were the same as in the latter year, and  attended
 with the  same success.  Dr. Caldwell and Dr. Steuart,
 whose  practice was extensive in Southwark, informed me
 those remedies  had  been generally successful  in their
 hands.
   The only new medicine that the experience of  this year
 suggested  in this disease, was for one of its most dis-
tressing and dangerous symptoms, that is, the vomiting
which  occurs in its second stage.  Dr. Physick discover-
ed, that ten drops of the spirit of turpentine,  given every
two hours, in a little molasses, or syrup, or sweet oil, effec-
tually checked it in several instances, in patients who after-
wards recovered. It was administered with equal success
 • This  extensive district is continued, from the city of Philadelphia, along
the Delaware, but is not subject to its government. 
BILIOUS YELLOW FEVER OF 1805.       97
in a case which came under my care, after an absence of
pulse, and a coldness of the extremities had taken place.
Dr. Church informed me that he gave great relief to the
sick in the city hospital, by this medicine, by prescribing
it in glysters, as well as by the mouth, in distressing affec-
tions of the stomach and bowels.
   Dr. Steuart observed that all those persons who had
been affected by the yellow fever in former years, had mild
remittents in the same situations that others had the pre-
vailing epidemic in a malignant form.
  In one of four bodies the Doctor examined, he found
six, and in another three intussusceptions of the intestines,
without any signs  of inflammation.  He discovered the
common marks of disease from this fever in other parts of
those  bodies.
  The deaths from this fever amounted to between three
and four hundred.  They would probably have been more
numerous, had not those families who were in competent
circumstances fled into the country, and had  not the poor
been removed, by the board of health,  from the infected
atmosphere of Southwark, to tents provided for them in
the neighbourhood of the city;  and they would probably
have been fewer,  considering the tractable nature of the
disease, when met by suitable remedies in its early stage,
had not the  sick concealed their indisposition, in many
instances, for two or three days, lest they should be drag-
ged to the city hospital, or have centinels placed at their
doors to prevent any communication with their friends and
neighbours.   While these attempts were made to check
the progress of the fever,  it did not escape the notice of
many of the citizens of Philadelphia, that not a single in-
stance occurred of its being communicated by contagion,
in any of the families in the  city,  in which  persons had
sickened or died with it, and that while the sick were de.
 {irived of the kind offices of their friends and  neighbours,
 est they should be infected, physicians, and the members
of the board of health, passed by the guards every day, in
their visits to the same sick people, and afterwards mixed
with their fellow-citizens, in every  part of the city, with-
out changing their clothes.
   The yellow fever appeared early  in the season in New-
Heaven, in Connecticut, and in Providence, on Rhode*
   vol. i^.                   N 
98            AN  ACCOUNT OF THE, &C.

Island, in both of which places it was derived from putrid
exhalation,  and was speedily and effectually checked by
removing the healthy persons who lived in its neighbour-
hood to a distance from it  Several sporadic cases of it
occurred  during the antumn in Gloucester county,  in
New-Jersey, and in Mifflin and Chester counties, in Penn-
sylvania.  It was epidemic in New-York at the same time
it prevailed in Southwark and Philadelphia.   The follow-
ing extract of a letter from the health officer of New-York,
to one of his friend, contains a  satisfactory proof that it
was not, in that city, an imported disease.

                    Quarantine-ground, Sep. 7, 1805.
   I most sincerely and tenderly deplore the unfortunate
situation of our city.  What do people  say now of the
origin of the disease ? You  may state for the information
of those who wished to be  informed,  that  not a single
vessel, on board of which a person has been sick with fever
of any kind, or on board of which any  person has died
with any disease, while in the West-Indies, or on the voy-
age home, has ever gone up to the city during the whole
season.   This we  know,  and this we  vouch for;  and
 farther state, that  all the cases of fever that have come
down as from the city, have been all people of, and belong-
 ing to the city, and unconnected with the shipping, ex-
 cepting one, a sailor, who had no connection with any foul
 vessel.  There is not a shadow of proof or suspicion that
 can attach to the health-office,  or to infected vessels, this
 season.
                      I am, &c.
                         JOHN R.  B.  RODGERS. 
              AN






ACCOUNT OF THE DISEASES






               OF






        1806,1807,1808, ANO 1809. 
 
AN ACCOUNT, &c.
    ON the 21st of January in the year 1806, Lieutenant
M*Keller died  of  a  yellow  fever accompanied with a
black  vomiting.  A  son of  Mr.  William Flintham in
Keys's-alley, died of the same disease, and with the same
black  discharge from his stomach on the 5th of  May.
On the 16th of June, there was  a partial  eclipse of the
sun.  The mercury descended in the thermometer during
its continuance,  between 9°, and 10°  in Philadelphia.
At Haverhill, in Massachusetts,  it fell from 92°  to 62°,
in the thermometer.  In  Boston the  mercury suddenly
mounted to a great height in the barometer.  During the
time of this partial darkness, fowls and cattle  near the
city, retired to rest, and all the maniacs  in the Pennsyl-
vania  hospital suddenly  became  silent,  but I  saw no
change induced in  the symptoms of the diseases of any
of the patients who were then under my care, by means
of this eclipse.   In the month of September the yellow
fever  prevailed in  the  penitential house at Richmond in
Virginia, where its origin was previously traced to do-
mestic putrefaction.
   In the month of March 1807, the influenza appeared at
the same time in nearly all the states  in the  Union.  It
prevailed in sporadic cases during the months of April,
May, June, and July, in Philadelphia, but in August it
became general. It affected children as well as adults, and
persons ill with other diseases, as well  as  the healthy.
Asthma, consumption, madness, parturition, and even  a
salivation afforded  no protection from it.  Seven old per-
sons between 80 and 100, and one of 107 died  with  it.
The bilious fever which prevailed in August  imparted to
it several of its symptoms.  These were obvious remis-
sions and intermissions, great pain in the back, an apparent
cessation of the symptoms of the disease on the third, and
 a return of them on the fourth  day,  cholera  morbus, 
 102        AN ACCOUNT OF THE  DISEASES

dysentery and an efflorescence upon the skin.  The dis-
ease appeared in one respect to be a monster.  Its head
and breast wore the characters of influenza, while its trunk
and limbs indicated it to be a bilious fever.
   It increased gradually until the 20th of August. After
which time it gradually declined.   This was evident not
only from general observations, but from a list which was
put into my hands  of  the number of persons that were
bled each day of the month, by one of  the most popular
bleeders in the city.
   Dr. Dorsey informed me that he had attended two per-
sons in the yellow fever in the course of this month.
   In February 1808, the measles made their appearance,
and prevailed during the months of March and  April.
They were at first of a  mild character, but afterwards they
became highly inflammatory, so  as to  require  frequent
and copious bleedings.
   In the  month of  August, bowel complaints were unu-
sually common among adults.   They were ascribed in
part to the use of bread made of flour, which had become
musty from having remained an unusual time in the mills
and stores, in consequence of the operation of the embar-
go law.   On the 17th of August I attended and cured
an apprentice of Mr.  William  M'Corkle,  who  had all
the common symptoms of a malignant yellow fever.
  The month of September was unusually dry and healthy.
The healthiness of a great number of the citizens of Phila-
delphia during this season, was ascribed to their  general
and constant employment in the open air, in all those arts
and labours which are connected with the building of two
churches, two  shot manufactories and 600 houses.
   The spring of the year 1809 was unusually cold, so as
to render vegetation every where in the neighbourhood of
Philadelphia eighteen days later than  in ordinary  years.
There were a number of cases of sporadic influenza in the
month of May.  On the first and second days of June,
fires were comfortable. The weather  in the two succeeding
summer months was uncommonly cool. On the 22d day
of July, Mr. Richard  Durdon,  the step son of William
Lewis, Esq. died of the yellow fever accompanied with
black and bloody discharges upwards and downwards, on
the fourth day of his disease. Its seeds were derived from 
of 1806, 1807, 1808, 1809.          103
some putrid fish in a store in Water-street between Walnut
and Chesnut-streets. Several other persons were affected
with the yellow fever, or lightly indisposed, from the same
cause.   By removing  the  putrid fish and cleansing the
store, the disease ceased  in  the course of a few weeks.
From the result of observations upon the degrees of heat in
Philadelphia, in June and July, between the year  1793 and
1809, collected and published by Mr. Cadwallader Evans
in the " True American," of the 2d of August 1809, it
appears, that the yellow fever has never been epidemic in
our city when the medium heat of those two  summer
months was below 79°, except in 1802 when it  was 78°,
and in which year not  more than 200 persons were  sup-
posed to have died of it.   The medium heat of June and
July of the present year, was but 74°.   Time alone can
determine, whether this moderate temperature of the air
will produce the same general exemption from the disease,
that  it  has produced in former years.*  There  was one
circumstance which favoured the expectation excited by
Mr. Evans's observations, of the city escaping an epidemic
yellow fever, and that was, a chronic, or protracted remit-
ting fever, of a  moderate grade, prevailed during the
months of July and August in every part of the city and
suburbs; from which it was natural to infer, the  constitu-
tion of the atmosphere did not dispose to malignant fevers.
   Upon the subject of the meteorological observations
published by Mr. Evans,  I shall only add, however ge-
nerally the yellow fever may require a greater degree of
medium summer heat to produce it than 79° in  Philadel-
phia, it is certain  fevers from exhalations  have often pre-
vailed  in other countries in a much lower temperature.
Dr.  Huxham and several other physicians describe  bili-
ous  fevers in open  winters, and particularly after a  sud-
den  thaw has succeeded a great frost, f
   From a number of observations made through a course
of many years by an intelligent  citizen of Philadelphia, I
am led to believe that an exemption from the yellow fever
in our city is intimately connected with the state of the
winds  in March and April.   The more they blow from
the north-west, the drier they are, and the more completely
  • This sentence was written about the middle of August 1809.
  + On air and epidemic diseases, vol. i p. Y9. 
 140     AN  ACCOUNT OF  THE DISEASES, &C.

they carry off the putrid matters which have been thrown
upon the surface of the earth by the warmth of the ver-
nal sun.  Those winds have been called " hungry," from
their being supposed to devour the matters  which they
convey from our sight.  A dry wind in the  spring, in a
certain part of Ireland, has  been observed to  produce the
same effect upon the healthiness of the succeeding months.
   Having concluded  the history  of the bilious yellow
fever as it has appeared in Philadelphia every year, 1808
only excepted, since 1793,  as an epidemic or in sporadic
cases, I shall proceed next  to enumerate  all  the sources
of that fever, as  well as all  the other usual forms of the
summer  and  autumnal disease of the United States, and
afterwards,mention the means of preventing them. 
              AN INQUIRY






                  INTO






        THE VARIOUS SOURCES






          OF THE USUAL FORMS OF







SUMMER AND AUTUMNAL DISEASE,






         IN THE UNITED STATES,






                AND THE






         MEANS OF PREVENTING THEM.
VOL. IV.
O 
 
AN  INQUIRY, &c
    THE business of the following inquiry is,
  I.  to enumerate the various sources of the usual forms
of the summer and autumnal disease of the United States.
And,
  II. To mention the means of preventing them.
  To render the application of those means as extensive
as possible, it will be proper to mention, under  the first
head, all those sources of summer and autumnal disease,
which have been known to produce it in other countries,
as well as in the United States.   They are,
  1. Exhalations from Marshes.  These are supposed to
be partly of a vegetable, and partly of an  animal nature.
They are derived from the shores of creeks and mill ponds,
as well as from low and wet grounds;  also from the follow-
ing vegetable substances in a state of putrefaction.
  2. Cabbage.   A malignant fever was produced at Ox-
ford, by a putrid heap of  this vegetable some years ago,
which proved fatal to many of the inhabitants, and to seve-
ral of the students of the university at that place.
  3. Potatoes.   Nearly a whole ship's crew  perished at
Tortola, by removing from her hold, a quantity of putrid
potatoes.
  4. Pepper.
  5. Indian meal.
  6. Onions.
  7. Mint.
  8. Anise and caraway seeds, confined in the hold of a
ship.
  9. Coffee. " About the time," says Dr. Trotter,<l when
notice was taken of the putrefying coffee on the  wharf at
Philadelphia, in the  year 1793, a captain of a man of war,
just returned from the Jamaica station,- informed me, that 
108
ON  THE  SOURCES OF
several  vessels laden with the same  produce came to
Kingston, from St. Domingo. During the distracted state
of that colony, this article, with other productions,  had
been allowed to spoil and ferment.  The evolution  of a
great quantity of fixed air, or carbonic acid gas, was the
consequence; and  in these  vessels, when opening the
hatchways, such was its concentrated state, that the whole
of the crew, in some of them, were found dead on the deck.
A pilot boarded one  of them in this condition, and had
nearly perished himself."*
   10.  Chocolate shells.
   11.  Cotton which had been wetted on board of a vessel
that arrived in New-York, a few years ago, from Savannah,
in Georgia.
   12.  Hemp, flax, and straw.
   13.  The canvas of an old tent.
   14.  Old books, and old paper money, that had been
wetted, and confined in close rooms and closets.
   15.  The timber of an old house.  A fever produced by
this cause is mentioned by Dr. Haller, in his Bibliotheca
Medicinae.
   16. Green wood confined in a close  cellar during the
summer months.   A fever from this cause was once pro-
duced in this city, in a family that was  attended by the
late Dr. Cadwallader.
   17.  The green timber of a new ship.  Captain Thomas
Bell informed me, that in a voyage to the East-Indies, in
the year 1784, he lost  six of his  men with the scurvy,
which he supposed to be derived wholly  from the foul air
emitted by the green timber of the ship.   The hammocks
which were near the  sides of the ship  rotted  during the
voyage, while those which were suspended in the middle
of the ship, retained their sound and natural state.   This
scurvy has been lately  proved by  Dr. Claiborne, in an
ingenious inaugural dissertation, published inPhiladelphia,
in the year 1798,  to be a misplaced state  of malignant
fever.  Dr. Lind  mentions likewise the timber of  new
ships as one of the sources of febrile diseases.  The tim-
ber of soldiers' huts, and of the cabins of men who  follow
the business of making charcoal in the woods, often pro-
                 *Medicina Nautica. p. 324. 
         SUMMER AND AUTUMNAL  DISEASE.     109

duce fevers, as soon as the bark begins to rot and fall from
them, which is generally on the second year after they are
erected.  Fevers have been excited even by the exhalation
from trees, that have been killed by being girdled in an old
field.
  18. The stagnating air of the hold of a ship.
  19. Bilge water.
  20. Water that had long been confined in hogsheads at
sea.
  21. Stagnating rain water.
  22. The stagnating air of close cellars.
  23. The matters which usually stagnate in the gutters,
common sewers, docks, and alleys  of cities, and in the
sinks of kitchens.  A citizen of Philadelphia, who had a
sink  in his kitchen, lost a number of cats and  dogs by
convulsions.   At length one of his servants was affected
with the same disease.  This led him to investigate  the
cause of it.  He soon traced it to his sink.  By altering
its construction, so as to prevent the escape of noxious air
from it, he destroyed its unwholesome quality, so  that all
his domestics lived in good health in his kitchen afterwards.
  24. Air emitted by  agitating foul and stagnating water.
Dr. Franklin was once infected with an intermitting fever
from this cause.
  25. A duck pond.   The children of a family in this
city were observed,  for several successive  years, to be
affected with a bilious remitting fever.   The physician of
the family, Dr. Phineas Bond, observing no other persons
to be affected with the same fever in the neighbourhood,
suspected that it arose from some local cause.  He exam-
ined the yard belonging to the house,  where he found an
offensive duck pond.   The pond was filled with earth, and
the family were afterwards  free from  an annual bilious
fever.
  26. A hog-stye has been known to  produce violent
bilious fevers throughout  a  whole neighbourhood in
Philadelphia.
  27. Weeds cut down and exposed to heat and moisture
near a house.
  Fevers are less frequently produced by putrid animal,
than by putrid vegetable matters.  There are, however, 
110
ON  THE SOURCES OF
 instances of their having been generated by the following
 animal substances in a state of putrefaction.
   1. Human bodies that have been left unburied upon a
 field of battle.
   2. Salted beef and pork.
   3. Locusts.
   4. Raw  hides confined in stores, and in the holds of
 ships.
   5. A whale thrown upon the sea shore in Holland.
   6. A large bed of oysters.  The malignant fevers which
 prevailed in Alexandria, inVirginia, in 1803, and in South-
 wark, adjoining Philadelphia, in  the year 1805, were de-
 rived from this cause.*
   7. The entrails of fish.  And,
   8. Privies.  The diarrhcea and dysentery are produced,
 oftener than any other form of summer and autumnal dis-
 ease, by the fcetor of privies.   During the revolutionary
 war, an American regiment, consisting of 600 men, were
 affected with a dysentery,  from being  encamped near a
large mass of human fasces.   The disease was  suddenly
checked by removing their encampment to a distance from
 it.   Five persons in one family were affected with the yel-
 low fever in Philadelphia, in 1805, who  lived in a house in
which a privy in the cellar emitted a most offensive smell.
No one of them had been exposed to the foul air of South-
 wark, in which the fever chiefly prevailed in the autumn
of that year.  Three of them sickened at the same time,
which obviated the suspicion of the disease being produ-
 ced by contagion.
   The miasmata  which are exhaled from putrid vegetable
and animal  matters, are much varied by circumstances, in
their effects upon the body.  Certain  vegetables, particu-
larly coffee, potatoes, and hemp, in a state of putrefaction,
exhale a more noxious gas than any other vegetables, and
putrid salted meat and fish, are more disposed to produce
malignant fevers than meat and fish that are fresh, and both
 are more destructive when they exhale their miasmata from
  • It has been a common practice with many families, in New-York and
 Philadelphia, for several  years  past, to lay in a winter store of oysters in
 their cellars in thetfall of the year.   May  not a part of these oysters, left
 in these cellars from forgetfulnesa, or from being unfit for use, become, by
putrefying there, the cause of malignant fevers in the succeeding summer
 and autumn I 
         SUMMER AND  AUTUMNAL DlSEASt.     Ill

places which have been  confined,  than in the open  air.
This is  one reason why  the yellow fever generally makes
Its first  appearance and is attended with most mortality
near the wharves and water streets of sea port towns, the
miasmata in such places being emitted from putrid ani-
mal and vegetable matters, which  had been confined in
stores, cellars and the holds of ships.
  There are several other sources of malignant fevers
besides  those which have been mentioned.  They are, ex-
halations from volcanoes, wells,  and  springs of water;
also flesh,*  fish, and vegetables, eaten  in a putrid state;
but these seldom act in  any  country,  and  two of them
only,  and that rarely, in the United States.
  It has been said that we sometimes meet with  bilious
fevers in situations where no exhalations had taken place
from any of the sources that  have  been enumerated.  Dr.
Gordon informed me that 500 persons died of the yellow
fever in Berbice between July 1804 and May 1805, during
which time there fell not quite three inches of rain. The
earth in this case was every  where dry and parched. Bi-
lious  fevers, Sir John Pringle tells us, occur in a  part of
Holland in  very dry seasons, but  in these cases the earth
stagnates below its  surface.  The same cause which prp«
duced these fevers in Holland, probably induced the fe-
ver at Berbice, mentioned by Dr. Gordon, as also all such
bilious fevers as appear  under  the  same  circumstances
of the apparent absence  of moisture and putrefaction.
  The usual forms  of the disease  produced by miasmata
from the sources of them  which  have been enumerated
are,
   1.  Malignant or  yellow bilious fever.
  2.  Inflammatory bilious fever.
  3.  Mild  remittent.
  4.  Mild  intermittent.

  * The following fact, communicated to me by Mr. Samuel Lyman, a mem •
ber of congress from the state of Massachusetts, shows the importance of u<'
tending to ihe condition of butcher's meat in our attempts to prevent malig-
nant fevers.
  A farmer in New-Hampshire,  who had overheated a fat oX by excessive
labour in the time of harvest, perceiving him to be indisposed, instantly killed
him, and sent his flesh to  a neighbouring market. Of twenty-four person*
who ate of this  flesh, fifteen died in a few days. The fatal disease product
by this aliment fell, with its chief force, upon  the stomach and bowels. 
 112        OF THE MEANS OF PREVENTING

   5.  Chronic, or what is called nervous fever, or the au-
 tumnal fever in a protracted form.
   6.  Febricula.
   7.  Dysentery.
   8.  Cholic.
   9.  Cholera  morbus.
   10. Diarrhoea.
   In  deriving all the above forms of disease  from mias-
 mata, I do not mean to insinuate, that sporadic  cases of
 each of them  are not produced by other causes.
   In  designating them by a  single name,  I  commit  no
 breach upon the ancient nomenclature of medicine.  The
 gout affects not only the blood-vessels  and bowels,  but
 every other part of the body, and yet no writer has, upon
 that account, distinguished it by a plural epithet.
   The four last forms of disease, that  have  been men-
 tioned, have been  very properly called intestinal states of
 fever.  They nearly accord, in their greater or less degrees
 of violence and danger, with the first four  states of fever
 which occupy the blood-vessels, and in the order in which
 both of them have been named. I shall illustrate this re-
 mark  by barely mentioning the resemblance of the yellow
fever  to the dysentery*, in being attended with costiveness
 in its  first stage, from a suspended or defective secretion
or excretion of bile, and in terminating very generally in
 death, when not met by the early use of depleting reme-
 dies.
   The variety in the forms and grades of the summer and
 autumnal disease, in different seasons, and their occasional
 changes into each other in the same seasons, are to  be
 sought for in the variety  of  the sensible and insensible
qualities of the atmosphere, of the course of the winds,
 and of the aliments of different years.
   II.  The means of preventing the different forms of dis-
 ease that have been mentioned, come next under our con-
 sideration.
   Happily for mankind, Heaven has kindly sent certain
 premonitory signs of the most fatal of them. These signs
 appear,
   I. External, in certain  changes in previous diseases,
 in the atmosphere, and in the animal and vegetable creation. 
         SUMMER AND AUTUMNAL DISEASE.     113-

   II. In the human body.
   1. The first external premonitory sign that I shall men-
tion is, an unusual degree of violence in the diseases of
the previous year or season. Many proofs of the truth of
this remark  are to be met with in the works of Dr. Syden-
ham.  It has been confirmed in Philadelphia, in nearly all
her malignant fevers since the year 1793. It would seem
as if great and mortal epidemics, like  the  planets, had
satellites revolving round them, for they are not only pre-
ceded, but accompanied and followed, by diseases which
appear to reflect back  upon them some of their malignity.
But there is an exception to this remark, for we now and
then observe uncommon and general healthiness,  before
the appearance  of a malignant epidemic.   This was the
case in Philadelphia, previously to the fevers of 1798 and
1799.   I have ascribed  this to the stimulus of the pesti-
lential miasmata barely  overcoming the action of weak
diseases, without being  powerful enough to excite a ma-
lignant fever.
  2. Substances, painted with white lead, and exposed
to the air, suddenly assuming a dark colour; and winds
from unusual quarters, and unusual and long  protracted
calms, indicate  the approach of a pestilential disease.
The south winds have blown upon the city of Philadel-
phia, ever since  1793, more constantly than  in former
years. A smokiness or mist in the air, the late Dr. Mat.
tlitw Wilson has remarked, generally precedes a sickly
autumn in the state of Delaware.
  3. Malignant and mortal epidemics are often preceded
by uncommon sickness and mortality among certain birds
and beasts.  They have both  appeared, chiefly among
wild pigeons and cats, in the United States.   The  mor-
tality among cats,previous to the appearance cf epidemics,
has been taken notice  of in other countries. Dr. Willan
says it occurred in the city of London, between the 20th
of March and the 20th of April, in the year 1797, before
a sickly season, and Dr.  Buneiva says it preceded a mortal
epidemic in  Paris.  The cats, the Doctor remarks,  lose
on the second day of their disease, the power of emitting
electrical sparks from their backs, and, when thrown from
a height, do  not, as in  health, fall upon their feet.*
                   " Medical Journal, vol. iv.
   VOL. IV.                  P 
114       ON  THE MEANS OF PREVENTING

   4.  The common house fly has nearly disappeared from
our cities, moschetoes have been multiplied, and several
new insects have appeared, just before the prevalence of
our late malignant epidemics.
   5.  Certain trees have emitted an  unusual  smell;  the
leaves of others have fallen prematurely; summer  fruits
have  been less in  size,  and of  an inferior quality; and
apples and pears have been knotty, in the summers pre-
vious to several of our malignant autumnal fevers.  Dr.
Ambrose Parey says, an unusually rapid growth of mush-
rooms once preceded the plague in Paris.
   II. The premonitory signs of an approaching  malig-
nant  epidemic in the human body are,
   1.  A sudden drying up, or breaking out of an old sore;
fresh eruptions in different parts of the body;  a cessation
of a  chronic disease, or a conversion of a periodical into
a continual disease.   Of this there were many instances
in Philadelphia, in the year  1793.
   2.  A peculiar sallowness of the complexion. This was
observed to  be general in Philadelphia, previous  to the
yellow fever of 1793.  Dr. Dick informed me, that he had
observed the same appearance in the faces of the  people
of Alexandria, accompanied in some cases with a yellow-
ness  of the eyes, during the summer of 1793, and previ-
ous  to the  appearance  of a violent bilious fever on the
banks of the  Potowmac.
   3. I have observed one or more of the following symp-
toms, namely, head-ach; a decay, or increase  of appetite;
costiveness; a diminished or increased secretion of urine;
a  hot and offensive breath;*  constant sweats, and  some-
times of a fcetid nature, or a dry skin;  wakefulness,  or a

   * I have once known this breath, in  a gentleman who had carried ihe seeds
of the yellow fever in his body from Philadelphia into its neighbourhood, cre-
ate sickness at the stomach in bis wife; and I have heard of an instance in
which-a person, who left Philadelphia when highly impregnated with the mi.
asmata of the same fever, creating sickness at the stomach in fo'jr or five per-
sons who sat at the same table with him in the country. None of the above
persons were afterwards affected by the fever. In an anonymous history of the
plague in London, in the year 1664, in the possession of the author, it is said,
the breath was a well-known signal of infection to persons who were not in-
fected, and that  whenever it was perceived, individuals and  companies fled
from it. The sickness in the above-mentioned persons was similar to that which
is  sometimes excited by the smell of a sore leg, or a gun-shot wound, upon the
removal of its first dressing. It does not produce fever, because there is no
predisposition to it. 
          SUMMER AND AUTUMNAL DISEASE.     115

disposition to early or protracted sleep;  a preternaturally
frequent pulse;  unusual vivacity, or depression of spirits;
fatigue and sweats from light exertions; hands, when rub-
bed, emitting a smell like hepar sulphuris; and, lastly, a
sense of burning in the mouth; to be present in different
persons, during the prevalence of our malignant epidemics.
  The means of preventing the different  forms  of our
summer and autumnal disease comes next under our con-
sideration.   I shall first mention such as have been most
effectual in guarding against its malignant form, and af-
terwards take notice of such as are proper in its milder
grades.  These means naturally divide themselves again,
  I. Into such  as are proper to protect individuals.
  II. Such as are proper to defend whole communities
from the disease.  And,
  III. Such  as are proper to exterminate it, by removing
its causes.
  I. Of the  means of protecting individuals.
  Where flight is practicable, it should be resorted to in
every case, to avoid an attack of a malignant fever.  The
heights of Germantown and Darby have, for many years,
afforded a secure retreat to a large number of the citizens
of Philadelphia, from their late annual epidemics.  It were
to be wished our governments possessed a power of com-
pelling our citizens to desert the whole, or parts, of infect-
ed cities and villages.   In this way the  yellow fever  was
suddenly annihilated in Providence, on Rhode-Island, and
in New-Haven, in Connecticut,  in the year 1805.  But
the  same power should rigorously prevent the removal of
the sick, except it be that class of them which have neither
homes nor friends.  The less the distance they are carried
beyond the infected atmosphere, the better.  The injury
sustained by  conveying them  in  a  jolting carriage,  for
two or three  miles, has often been proclaimed in the re-
ports of our  city hospitals, of patients  being admitted
without a pulse, and dying a few hours afterwards.
  In leaving a place infected by miasmata, care should be
taken not to expose the body to great cold, heat,  or  fa-
tigue, for eighteen or twenty days, lest they should excite
the  dormant seeds of the disease into action.
  But where a  flight is not enforced by law, or where it is
not practicable, or preferred, safety should be sought for 
116
ON  THE MEANS Of PREVENTING
in such means as reduce the preternatural tone and fulness
induced in the blood-vessels by the stimulus of the mias-
mata,  and the suppression  of customary secretions.—
These are,
   1. A diet, accommodated to the greater or less exposure
of the  body to the action of miasmata, and to the greater
or less degrees of labour, or exercise, which are taken. In
cases of great exposure to  an infected atmosphere, with
but little exercise, the diet should be simple in its quality,
and small in its quantity.   Fresh meats and wine should
be avoided. A little salted meat, and Cayenne pepper with
vegetables, prevent an undue languor of the stomach, from
the want of its usual cordial aliments.   The less mortality
of the yellow fever in the French and  Spanish West-India
islands than in the British, has been justly attributed to the
more temperate habits of the natives of France and Spain.
The Bramins, who live wholly upon vegetables, escape the
malignant fevers of India, while whole regiments of Euro-
peans,  who eat animal food, die in their neighbourhood.
The people of Minorca, Dr. Cleghorn says,  who  reside
near gardens,  and live chiefly upon fruit during the sum-
mer, escape the violent autumnal fever of that island. The
Jews in Surinam, Dr. Nassy tells us in his history  of the
settlement, escape bilious fevers,  by eating fruit  at 12
o'clock, and using fish oil,  and a considerable quantity of
spices, particularly pepper in their aliment, while the chris-
tians who eat and drink agreeably to their European habits,
perish  in great numbers  by  those diseases.   The field
negroes of South-Carolina owe  their exemption from bi-
lious fevers to their living chiefly upon vegetables. There
is a fact which shows, that  not only temperance,  but  ab-
stinence bordering upon famine, has aftbrdtd a protection
from malignant fevers.  In a letter which I ieceived a few
months ago, from  the Rev. Thomas Hall, chaplain  to the
British factory at Leghorn, containing an account of the
yellow fever which prevailed in that city, in the summer
and autumn of 1804, there is the followingcommunication.
" Of the rich,  who live in airy houses, there died but four
persons with the fever.  Of the commodious, who live
comfortably, but not affluently, there died ten.  Of  the
poor, who inhabited small  and crowded rooms, in  tlje
dirty and Confined parts of the city,there died nearly  seven
hundred.  But of the beggars, who had scarcely any thing 
         SUMMER AND AUTUMNAL -DISEASE.     117

 to eat, and who slept half naked  every night upon hard
 pavements, not one died."   From the reduced and ex-
 hausted state of the system in these people they were inca-
 pable, if I may be allowed the expression, of the combus-
 tion of fever.  Persons reduced by chronic  diseases,  in
 like manner, often escape such as are acute.  Six French
 ships of the line landed three hundred sick, at St. Domin-
 go, while the yellow fever prevailed there in  the year 1745,
 and yet no one of them was infected by  it.*
   Where the body is exposed to miasmata, and a  great
 deal of exercise taken  at the same time, broth,  a little
 wine, or malt liquors,  may be  used with the fruits and
 garden vegetables of the season,  with safety  and ad van-
*tage.  The change from a full to a low diet should be
 made gradually.   When made suddenly,  it  predisposes
'to an attack of the disease.
   2. Laxative medicines.  Hundreds, perhaps thousands,
''of the citizens of Philadelphia were indebted for their pre-
 servation from the yellow fever, to the occasional use of a
 calomel pill, a few grains of rheubarb, or a table spoonful
 of sweet, or castor oil, during the prevalence of our late
 pestilential fevers.   Even the air of Batavia has been de-
 prived of its poisonous quality, by means  of this class of
 medicines.  A citizen of Philadelphia asked a captain of a
 New-England ship,  whom he met at that island, how he
 preserved the whole  crew of his ship in health, while half
 the sailors  of all  the other ships in the harbour were sick
 or dead.   He informed him, that it was by giving each
 of them a  gentle purge of sulphur every day.
   3. A plentiful perspiration, or moderate sweats, kept up
 by means of warm clothing and bed clothes. The excretion
 which takes  place by the skin, is a discharge of the first
 necessity.   I have never known an instance of a person's
 being attacked by the yellow fever in whom this discharge
 was constant, and equally diffused all over the  body.  Its
 effects are  equally salutary in preventing the plague.  So
 well known is this fact, that Mr. Volncy informs us in his
 Travels into Egypt, that the common salutation at Cairo,
 during the prevalence  of the plague, is,  u  Do you sweat
 freely?"  For  the purpose of promoting this excretion,
 flannel shirts or waistcoat9 worn next to the skin have been
                  •  Desportes, vol. i. p. 140. 
118      ON THE MEANS OF PREVENTING

found more useful than linen.   As the perspiration and
sweats, which are thus discharged in a Pestilential season,
are often unusual in their quantity, and of a morbid quality,
clean body-linen or flannel should be put on every day,
and where this is not  practicable, that which  has been
worn should be  exchanged every morning and evening
for that which has been exposed during the previous day
and night, in a dry air.
   4. Blood-letting. In addition  to the authorities of Dr.
Haller  and Dr. Hodges, mentioned in another place,* in
favour  of this remedy, I shall subjoin a few others.  Dr.
Mitchell, in his  Account of the Yellow Fever which pre-
vailed in Virginia, in  the year 1741, informs us,  that it
was often prevented in persons who were under the influ-
ence of its remote cause, by the loss of a few ounces of
blood.   It was formerly a practice among the Physicians
in St. Domingo, to bleed whole regiments of troops as
soon as they arrived from France, by  which means they
were preserved from the malignant fever of the island.
   During the short visit paid to this city, in the year 1798,
by Dr.Boland,a respectable physician of the British army,
he put into my hands the following communication. t( In
the beginning of the August, 1797, 10i> Dutch artillery
arrived at Port au Prince, in the Bangalore transport. The
florid appearance of the men, their cumbersome clothing,
and the season of the year, seemed all unfavourable omens
of the melancholy fate we presumed awaited them. It was,
however, thought a favourable opportunity, by Dr. Jack-
son and myself,  to try what could be done in warding off
the fever.   It  was accordingly suggested to  Monsier
Conturier, the chief surgeon of the foreign troops, and the
surgeon of the regiment, that the whole detachment should
be blooded freely, and that, the morning after, a dose of
physic should be administered to every man.  This was
implicitly complied with, a day or two after, and at this
moment in  which  I  write, although a period of four
months has elapsed, but two of that detachment have died,
one of whom was in  a dangerous state when he landed.
A success unparalleled during the war in St. Domingo!
It is true, several have been attacked with the disease, but
           • Account of  the YeiWw Peyer in 1793, vol. iii. 
         SUMMER AND AUTUMNAL DISEASE.     ll£

ia those the symptoms were less violent, and readily sub-
sided by the use of the lancet.
  "  i he crew of the Bangalore, on her arrival at Port au
Prince, consisted of twenty-eight men.   With them no
preventive plan was followed. In a very few weeks, eight
died, and at present, of the original number, but fourteen
remain."
  All these depleting remedies, whether used separately
or together, induce such an artificial debility in the system,
as disposes it to vibrate more readily under the impression
of the miasmata.  Thus  the willow  rises, after bowing
before a  blast of  wind, while the unyielding oak falls to
the ground by  its side.  It is from the similarity  of the
natural weakness in the systems of women, in the West-
Indies, with that  which has been induced by the artificial
means that have been mentioned, that they so generally
escape the malignant endemic of the islands.
   A second class of preventives of malignant fever are
such as obviate the internal action  of miasmata, by ex-
citing a general or partial determination to the  external
surface of the body.   These are,
   1. The warm bath.  I have known this grateful remedy
used with success in our city.   It serves the treble pur-
poses of keeping the skin clean, and the pores open, and
of defending what are called the vital  organs from  dis-
ease, by inviting its remote cause to the external  surface
of the body.
   2. The cold bath, or cold water applied to the external
surface of the body.   Ulloa, in his travels through Cuba,
tells us the Spaniards  make it a practice, when  partially
wetted by rain,  to  plunge  themselves, with their wet
clothes on, into the first  stream of  water they meet with
afterwards, by which means they avoid taking the fever of
the  island.  When this cannot be conveniently done, the
peasants strip off their clothes, and put them under a shel-
ter, and receive showers of rain upon their naked bodies,
and thus preserve themselves from the fever. Dr. Bay-
nard has left it  upon record, in  his treatise upon the
cold  bath, that  those  persons  who  lived in  water-
mills, also watermen, bargemen, and fishermen,  who
were employed upon the river, and in  dabbling  in  cold
 water, were rarely affected by the  plague  in London  in 
120       ON THE  MEANS OF PREVENTING

1665, and that but two persons died with it on London
bridge.   The water carriers at Cairo, Mr. Volney  says,
uniformly escape the plague; and, Dr. Chisholm inlorms
us, that those negroes in Demarara  who go naked, and
are thereby disposed not to  avoid showers  of rain, are
never affected with  the fever of that country.
   3. Washing the body every morning and evening with
salt water.   A whole ship's crew from Philadelphia was
preserved by this means from the  yellow  fever,  some
years ago, in one of the West-India islands, while a large
proportion  of the crews of several  ships, that lay in the
same harbour, perished by that disease.
   4. Anointing the body with oil. The natives of Africa,
and some American Indians, use this  preventive with
success during their sickly seasons.   It has lately been
used, it is said, with effect in preventing the plague.  Its
efficacy for that purpose was first suggested by no oilman
having died of that disease during four  years, in which
time 100,000 people perished with it in Egypt.  Oliver,
in his travels into that country, says, the men who make
and sell butter, are  equally fortunate in escaping it.
   5. Issues,  setons, and blisters, belong to this class of
preventives of malignant and bilious fevers.
   Issues, according to Parisinus, Florentinus, and several
other authors quoted by Diemerbroeck, have  prevented
the plague in many hundred instances. Parcaeus says, ail
who had ulcers from the venereal disease,  or any  other
cause, escaped it. Dr. Hodges owed his preservation from
the plague in London, in 1665, to an issue in his leg.  He
says he always felt a slight pain in it when he went into a
sick room.  "Dr. Gallager ascribed  his escape from  the
yellow fever  of 1799 to a perpetual blister, which he ap-
plied to his arm for that purpose.  Dr.  Barton favoured
me with a sight of a letter from Dr. James Stevens, dated
January i2th, 1801, in which he  says he believed Dr.
Beach (formerly of Connecticut,) had been preserved from
the bilious fever by a seton in his  side.  He adds further,
that Dr. Beach had been called to attend the labourers at
Onandogo salt springs, in the state of New-York, ninety-
eight of whom out of a hundred had the bilious fever.  Of
the two who escaped it, one had a sore leg, the other what
is called a scald head.  The discharge from the sores in 
SUMMER AND AUTUMNAL DISEASE.
121
 each of them,  as well  as  from the doctor's issue, was
 more  copious during the prevalence of the fever, than it
 had been at any other lime.
   A third class  of preventives of malignant fever,  are
 such as excite a general action, more powerful than that
 which the  miasmata are disposed to create in the system,
 or an action of a contrary nature.   These are,
   1.  Onions and garlic.  All those  citizens who used
 these vegetables in their diet, escaped the yellow fever in
 1793.  The greater exemption of the natives of France
 from this disease, wherever they are  exposed to it, than
 of the inhabitants  of other European  countries, has been
 ascribed in part to the liberal  use of those condiments in
 their food.   The Jews, it has been said, have often owed
 to them their preservation from the  plagues which for-
 merly  prevailed in  Europe.   It is  probable leeks and
 onions, which to this day form a material part of the diet
 of the inhabitants of Egypt,  were cultivated  and  eaten
 originally as  the means of obviating the  plagues of that
 country.   I have been at a loss to know why the Author
 of Nature, who has endowed these  vegetables with  so
 many  excellent qualities for  diet and medicine, should
 have accompanied them with  such a disagreeable  smell.
 Perhaps the  reason  was, kindly to force them into uni-
 versal use; for it is remarkable  their smell in the breath
 is imperceptible to those who use them.
   2.  Calomel, taken in  such small doses as gently  to
 affect the gums.  It preserved most of the crew of a
 Russian ship at  Plymouth, in the year 1777, from a fever
 generated by filth in her hold.   In a letter which I receiv-
 ed from Captain  Thomas  Truxton, in the year  1797,
 he informed  me, that an old and respectable merchant at
 Batavia had assured him, he had been preserved in good
 health by calomel, taken in the way that has been  men-
 tioned, during the sickly seasons, for upwards of  thirty
 years. The mortality of the fevers of that island may easily
 .be conceived of, when I add, on the authority of a physi-
 cian quoted in  Sir George Staunton's Account  of his
 Embassy to China,  that one half of all new comers die
^there on the first year of their  arrival.
..  VOL. IV,                % 
122       ON THE MEANS  OF PREVENTING
  Our principal dependence should be placed upon those
two preventives under this head.  There are several others
which have been in common use, some of which I be-
lieve are hurtful, and the rest are of feeble, or doubtful
efficacy.  They are,
  3.  Wine and  ardent  spirits.   They  both prevent  a
malignant  fever, only when they excite an action in the
system above that which is ordinarily excited by the mias-
mata  of the fever; but this cannot  be done without pro-
ducing intoxication, which, to be effectual, must be per-
petual;  for the  weakness  and excitability, which take
place in the intervals of drunkenness, predispose to the
disease.  Agreeably  to thjis remark,  1 observed three
persons, who were constantly drunk, survive two of our
most  fatal  epidemics, while all those persons  who  were
alternately drunk and sober, rarely escaped an attack of
the fever.  In most of them it terminated in death.
   4.  Tobacco.   Many hundreds of the citizens of Phi-
ladelphia can witness,  that no benefit was derived  from
this weed, in any of the ways  in which it is  commonly
used, in the  late epidemics of our city.   Mr. Howard
says it  has no effect  in preserving from the plague.
   5.  Camphor suspended in a bag round the neck, and
rags wetted in vinegar,  and applied to the  nose.  These
means were in general  use in the fever of 1793, in Phi-
ladelphia, but they afforded no protection from it.  It  is
possible they had a contrary effect, by entangling in their
volatile particles, more  of the miasmata of the fever, and
thus  increasing a predisposition to it.
   A  fourth class of  preventives of malignant fevers are-
 certain  substances which are  said to destroy miasmata
 by entering into mixture with them.  Two persons, who
 were very much exposed to the  causes of the  fever in
 1798,  took each of  them a table  spoonful of sweet oil
 every morning.  They both escaped the fever.  Did the
 oil,  in tliese  cases,  act by  destroying miasmata in the
 stomach chemically? or did it defend the stomach me-
 chanically from their action? or did it prevent the disease,
 only by gently opening the bowels?  It is  certain the fat
 of pork  meat protects the men who work in the lead
 mines  of Great-Britain  from the deleterious eflects which 
SUMMER AND  AUTUMNAL DISEASE.
123
the fumes of that metal are apt to bring upon the stomach
and bowels, and that a poisoned arrow, discharged into
the side of a hog, will not injure him,  if it be arrested
by the fat which lines that part of his body.
  The vapours which issue from fresh  earth  has  been
supposed to destroy the miasmata which produce malig-
nant fevers, by entering into mixture with them.   Most
of the men who were  employed in digging  graves and
cellars, and in removing the dirt from the streets of Phi-
ladelphia, in 1793,  escaped the  fever  of that year.  In
the new settlements of our country, it is said, the poison
of the rattle snake is deprived of its deadly effects  upon
the body, by thrusting the wounded limb into a  hole
recently,  made in the earth.  The fable  of Anteus who
rose with renewed strength from the ground after repeated
falls,  was probably  intended  to signify, among  other
things, the salutary virtues which are  contained in the
effluvia which issue from fresh clods of earth.
  3. There are  many facts which  show the  efficacy of
die volatile alkali in destroying,  by  mixture, the poison
of snakes.  One of them was lately communicated to
the public by Dr.  Ramsay, of South-Carolina.   What
would be the effect of the daily use of a few  tea-spoon-
fuls of this medicine in a liquid form, and of frequently
washing the body with it, during the prevalence of  pesti-
lential epidemics?
  The  miasmata which produce malignant fevers often
exist  in an offensive  state in  the body, for  weeks and
perhaps months, without  doing  any harm.  With  but a
tew exceptions, they seldom  induce a  disease without
the reinforcement of an exciting  cause.   In vain, there-
fore, shall we use all the preventives that have been re-
commended, without,
   V. Avoiding of all its exciting causes.   These are,
   1.  Heat and cold.  While the former has excited the
yellow fever in thousands, the latter has excited it in tens
of thousands.   It  is  not  in middle latitudes only that
cold awakens this  disease in the  body.  Dr.  Mosely
says it is a more frequent exciting  cause of that, and of
other diseases, in the island of Jamaica, than in any  of the
most temperate climates of the globe.   It is  this which 
124      ON THE MEANS OF  PREVENTING

fenders cases of yellow fever, when  epidemic in our
cities, more numerous in the cool months of  henttmber
and October, than in July and August   For the purpose
of avoiding this pernicious and universal influence of cold,
the clothing and bed-covers should be rather warmer in
those months, in middle and northern latitudes, than is
agreeable, and fires should be made every morning and
evening in common sitting rooms, and during ihe whole
day, when the weather is clamp or cool.   They serve  not
only to prevent  the reduction of the excitement  of  the
blood-vessels, by the gradual and imperceptible abstrac-
tion of the heat ol the body, but to convey  up a chim-
ney all the  unwholesome air that  accumulates in  those
rooms during a sickly season.   By these precautions, I
have  known whole families preserved in  health,  while
all the neighbours who neglected them, have  been  confi-
ned by a prevailing autumnal fever.
   3.  The early  morning and evening air, even in warm
weather.
   4.  Fatigue from  amusements, such as fishing,  gun-
ning and dancing, and from  unusual labour or exercise.
The effects of fatigue from this cause have been already
noticed,* in the maids of large families  being the only
persons  who die of the fever, in  consequence  of their
having performed great and  unusual services to those
branches of the family who survive them, while nurses,
who only exercise their ordinary habits in attending sick
people, are seldom carried off by it.
   5.  Intemperance in eating and drinking.
  6.  Partaking of new aliments and  drinks.   The sto-
mach, during the prevalence of malignant fevers,  is  al-
ways in an irritable state,  and constantly  disposed to be
affected by impressions that are not habitual to it.
   7.  Violent emotions or passions of the mind.
   8.  The entire cessation of moderate labour.  This, by
permitting the  mind  to ramble upon subjects of terror
and distress, and by expo-ing the body to idleness and
company, favours an  attack of fever.  A predisposition
to it,  ir. likewise created by alternating labour and idle-
ness,  with each other.
• Account of the Yellow Fever in 1793, vol. iii. 
        SUMMER AND AUTUMNAL  DISEASE.     125

  6. The continuance of hard labour.   The miasmata
which produce  malignant levers  sometimes  possess so
much force, that the least addition to it, even from cus-
tomary acts of labour, is  sufficient to excite the disease.
In this case, safety should be sought in retirement, more
especially by those persons whose occupations expose
them to the  heat of fires, and the rays of the sun, such
as hatters,  smiths, bricklayers, and house and ship car-
penters.  The wealthy inhabitants of Constantinople and
Smyrna, erroneously suppose they escape the contagion
of the plague, by shutting themselves up in their houses
during  its prevalence.    They owe their preservation
chiefly to their being removed, by an exemption from care
and business, from all its exciting causes.  Most of  the
nobility and gentry of Moscow, by these means escaped
a plague which  carried off 27,000 persons in that city,
in the\ ear 1771,  and many  whole families in Philadel-
phia were indebted for  their safety to the same precau-
tions in the year 1793.   Confinement is  more certain in
its  beneficial effects,  when  persons  occupy   the  upper
stories only of their houses.    The inhabitants of St.
Lucia, Dr.  Chisholm says,  by this means often  escape
the yellow fever of that island.   Such  is the difference
between the healthiness  of the upper  and lower stories
of a house, that  travellers tell us,  birds live in the for-
mer,  and die in the latter,  during the  prevalence of a
plague in the eastern countries.  But the benefits of con-
finement and rest, are by no means general in preserving
persons  from the plague and yellow fever.   Some late
accounts from Egypt, teach us that an atmosphere infec-
ted with putrid miasmata sometimes penetrates into the
retreats of the wealthy and the timid, and spreads with its
usual mortality  among them.  Solitary  instances of the
same  thing  have occurred  in  Philadelphia,  in  families
which have lived in retirement  during the prevalence of
the yellow fever.
   All the exciting causes that have been  enumerated
should be  avoided  with double care three days before,
and three days after,  as well as on the days of the full
and change  of the moon.   '1 he reason for this caution 
 126      ON  THE MEANS OF PREVENTING

 was given in the account  of the yellow fever in Philadel-
 phia in the year 1797.
   To persons  who had  retired from infected cities,  or
 countries, it will be necessary to suggest  a caution, not
 to visit them while the malignant fever from which they
 fled prevails in  them.  Dr. Dow informed  me, in his
 visit to Philadelphia  in the year 1800, that the natives
 and old citizens  of New-Orleans who retired into the
 country, and returned during the prevalence of the yel-
 low fever in that city, the year before, were  often affec-
 ted by it, while all such persons as did not change their
 residence, escaped it.  The danger from visiting an infect-
 ed city is greater to persons who breathe an atmosphere of
 a uniform temperature, than one that is subject to alternate
 changes in  its  degrees of heat  and cold.  The inhabi-
 tants  of  Mexico,  Baron  Humboldt informed me, who
 descend from  their elevated  situation, where  the ther-
 mometer  seldom  varies  more  than ten  degrees  in the
 year,  and visit  Vera Cruz during the prevalence of the
 vcllow fever in that city, are much oftcner affected by it
 than the new coiners from the variable climates of Euro-
 pean  countries.   But the  habits of  insensibility  to the
 impressions of the miasmata of this disease in one coun-
 try, do not always  protect the system from their action in
 another.   The  same  illustrious traveller  informed me,
 that the  inhabitants of the Havannah  who  visit Vera
 Cruz, and the  inhabitants of Vera Cruz  who visit the
 Havannah, are affected in common with strangers with
 the fever of those places.
  I shall take leave of this part  of our subject, by ad-
 ding,  that  I am so much  impressed  with a belief in the
 general, and almost necessary  connection of an exciting
 cause  with  a  yellow fever, that were  I to enter a city,
 und meet  its  inhabitants  under the  first impressions of
 terror  and distress from  its appearance,  my  advice  to
them should be, " Beware," not of contagion, for the
yellow fever of our country  is not contagious, nor of pu-
trid exhalations, where the duties of humanity or con-
sanguinity require your attendance, but " beware of
 EXCITING CAUSES!" 
        SUMMER  AND AUTUMNAL DISEASE.     127

  In the mild grades of the summer and autumnal fevers
of the United States, the means of prevention should be
different from those which have been recommended to
prevent the yellow  fever.   They consist of such things
as gently invigorate the system, and thus create an action
superior to that which  the  miasmata have excited in it.
The means commonly employed for this purpose are,
  1. Cordial diet and drinks;  consisting of salted meat,
and fish, with a moderate quantity of  wine  and malt
liquors.   Dr. Blane says, the  British soldiers who lived
upon salt meat,  during the American  war, were much
less afflicted with the intermitting fever, than the neigh-
bouring country people;  and,  it  is well  known, the
American army was much less afflicted with summer
and  autumnal fevers,  after  they exchanged their fresh
meat, for rations of salted beef and pork. Ardent spirits
should be used cautiously, for, when taken long enough
to do good,  they create a dangerous attachment to them.
A strong infusion of any bitter herb  in water, taken upon
an empty  stomach, is a cheap substitute for all the above
liquors where they cannot be afforded.  The Peruvian
bark has in  many  instances been used with  success as a
preventive of the mild grades of the summer and autum-
nal fevers  of our country.
  2.  An equable and constant perspiration.  This should
be kept up by all the means formerly mentioned for that
purpose.
   3. Avoiding certain exciting causes, particularly great
heat and cold, fatigue, long intervals between meals, in-
temperance,  and  the morning  and evening air, more
especially  during the  lunar periods formerly mentioned.
Dr.  Lind says, the farmers of Hokleraesse, in England,
who go out  early to their work, are seldom long lived,
probably from their constitutions being destroyed by fre-
quent attacks of intermitting fevers to which that  prac-
tice exposes them.   Where peculiar circumstances of
business render it necessary for persons to inhale the
morning air, care should be taken never to do it without
first eating a cordial breakfast.
   The intestinal state of our summer and autumi al dis-
ease requires several specific means to prevent it, different 
 128      ON THE MEANS OF  PREVENTING

 from those which have been advised to defend the blood-
 vessels from fever.  Unripe and decayed fruit should be
 avoided, and that which is ripe  and sound should not be
 eaten in an excessive quantity.  Spices,  and particularly
 Cayenne  pepper, and the red  pepper of our  country,
 should be taken daily with food.   Mr. Dewar, a British
 surgeon, tells us, the  French soldiers, while in Egypt,
 carried pepper in boxes with them,  wherever they went,
 to eat with the fruits of the  country, and thereby often
 escaped its diseases.   The whole diet, during the preva-
 lence of intestinal diseases, when they are not highly in-
 flammatory, should be of a cordial  nature.   A dysentery
 prevailed, a lew years ago, upon the Potomac, in a  part
 of the country which was inhabited by a number of pro-
 testant and catholic families.   The disease was observed
 to exist only in the former.  The latter, who ate of salted
 fish every Friday, and occasionally on  other days of the
 week, very generally escaped it.  In the year 1759, a dy-
 sentery broke out in the village  of Princetown, in New-
Jersey,  and affected many of the students of the college.
 It was remarked, that it  passed by all those boys who
 came from the cities ot New- York and Philadelphia. This
 was  ascribed  to their having lived more upon tea  and
coffee  than  the  farmers'  sons in the college; for those
 cordial  articles  of diet were  but rarely used, fifty years
 ago, in the farm  houses of the middle states of America.
 I mentioned formerly that the cordial diet of the inhabi-
 tants of our cities was probably the reason why the  dy
 sentery  so seldom prevailed as an epidemic in them.
  Another means of preventing the dysentery is, by avoid-
ing costiveness, and by occasionally taking purging physic,
even when the bowels are in their natural sta'.e. A militia
 captain, in the Pennsylvania service, preserved his whole
 company from a dysentery which prevailed  in a part ot
 the American army at Amboy, in the year 1776, by giv-
ing each of them a purge of sea-water.  He preserved his
family,  and many of his neighbours, some years after-
 wards, from the  same  disease, by dividing among  them
 a fewpoundsof purgingsalts. It was prevented, a few years
ago, in the academy of Bordentown, in New-Jersey, by
giving all the boys molasses,  in  large quantities, in their 
         SUMMER AND AUTUMNAL DISEASE*     120

diet and drinks.   The molasses probably acted only by
keeping the bowels in a laxative state.
  As the dysentery is often excited by the dampness of
the night air, great care should be taken to avoid it, and,
vrhen necessarily exposed to it, to defend the bowels by
more warmth than other parts of the body*  The Egyp*
tians, Mr. Dewar says, tie a belt about their bowels  fof
that purpose, and with the happiest effects*
  II. I come now, according to the order I proposed, tb
mention the means of preserving whole cities or commu-
nities from  the  influence of those morbid exhalations
which produce the different  forms of summer  and au»
tumnal disease, and, in particular, that which is of a ma-
lignant nature*
  As the flight of a  whole  city is rarely jn-acticable) it
will be necessary to  point out the means of destroying
 the morbid miasmata.
   1.  Where the putrid matters which emit them are of
a small extent, they should be covered with  water or
earth.  Purchas tells us, 500 persons less  died of the
plague the day after the Nile overflowed the ground which
had emitted the  putrid exhalations that produced it, than
had died the day before.  A bilious fever was once check-
ed in Brabant by inundating the marsh from whence the
miasmata came that produced it.  During the prevalence
of a malignant fever, it will be unsafe to remove putrid
 matters.  A plague was generated by an attempt  to re-
 move the filth which had accumulated on the  banks of
 the waters which surround  the city of Mantua, during
 the summer and autumnal months.*   Even a  shower of
 rain, by disturbing the green pellicle which is sometimes
 formed over putrid  matters, I shall mention in another
 place, has let loose exhalations that have produced a pes*
 tilential disease.                               .
   2. Impregnating the air with certain effluvia, which ftct
 either by destroying miasmata by means of mixture, of
 by exciting a new action in the system, has, in some in*
 strinces, checked the progress of  a malignant fever. The
 air extricated from fermenting wines, during a plentiful
 vintage, Vansweiten tells us,  has once checke&4he *ava*
                        • Burstr.us.
   VOL. IV.                     R 
 liO       ON THE MEANS OF PREVENTING

 ges of a plague in  Germany.  Ambrose Parey informs
 us, the plague was checked in a city in Italy by killing
 all the cats and dogs in the place, and leaving  them to
 putrefy in the streets.  Mr. Bruce relates, that all those
 persons who lived  in smoky houses, in one of the coun-
 tries which he visited,  escaped bilious fevers, and  Dr.
 Clark mentions an  instance, in which several cooks, who
 were constantly exposed to smoke, escaped a fever which
 Affected the whole crew of a galley.  The  yellow fever
 has never appeared within  the limits  of the effluvia of
 ihe sal ammoniac manufactory, nor of the tan-pits in the
 suburbs of Philadelphia, nor has the city of London been
 visited with a plague since its inhabitants have used sea-
 coal for fuel.   But other causes have  contributed more
 certainly to the exemption of that city from the plague
 For upwards of  a century,  one of which shall  be men-
 tioned under our next head.
   3.  Desquenette  tells us, the infection of the plague
 fiever crosses the Nile, and that it is arrested by means
 0f ditches, dug and filled with water  for that  purpose.
 Dr. Whitman has remarked, that the plague never passes
 from Abydos, on the Turkish, to Mito, on the Euro-
 pean  side of the water of the Dardanelles,  which forms
 the entrance to  Constantinople.   The  yellow  fever  has
 riever been known to pass from Philadelphia to the Jersey
 shore, and the miasmata generated on the east side of the
 Schuylkill rarely infect the inhabitants of the opposite side
 of the river. Many  persons found safety from the plague
 of London, in 1665, by flying to ships which lay in  the
 middle of the Thames, and, it is well known, no instances
 of yellow fever occurred in those Philadelphia  families
 that confined themselves to ships  in the middle of the
 Delaware, in the year 1793.  But three or four,  of four
 hundred men,  on board a ship of war  called the Jason,
 commanded by captain Coteneuil, perished with an epi-
 demic yellow fever, in the year 1746, at St. Domingo, in
 consequence, Dr. Desportes says, of her hold being con-
 stantly half jillec? with water.*  I have multiplied facts
 upon this  subject, because they,Iead to important con-
clusions.  They show the immense consequence of  fre-
quently washing the streets and houses of cities,  both to
                     • Vol. i p  161. 
         SUMMER  AND AUTUMNAL DISEASE.     131

prevent and check pestilential  fevers.  What  would be
the effect of placing tubs of fresh water in the rooms of
patients infected with  malignant fevers, and in  an atmos-
phere charged  with putrid  exhalations? Their efficacy
in absorbing the matter which constitutes the odour of
fresh paftrt, favours a hope that they would be  useful for
that purpose.   I have mentioned an instance, in the Ac-
count ot the Yellow Fever in Philadelphia, in the  year
1797, in which they were supposed to have been employ-
ed with evident advantage.
   4. Intercepting the passage  of miasmata to the inhabi-
tants of cities.  Varro in his Treatise upon Agriculture,
relates, that his namesake Varro, a Roman general, was
in great danger of suffering, with a large fleet  and army,
from a malignant fever at Conyra.   Having discovered
the course of the miasmata which produced  it  to be from
the south, he  fastened up  all the southern windows and
doors of the houses in which  his troops were  quartered,
and opened new ones to the north,  by  which  means he
preserved them from  the fever which prevailed in all the
other houses of the town and neighbourhood.  Mr. How-
ard advises keeping the doors and  windows,  of houses
which are exposed to the plague, constantly shut, except
during the time of sunshine.
   5.  Sir John  Pringle tells us, that the inhabitants of
Breda defend themselves from the morbid exhalations of
a piece  of marshy ground in its neighbourhood, in the
season of bilious fevers, by overflowing it with water.
   Several other means have been recommended to pre-
serve cities from malignant fevers during their prevalence,
which  are  of doubtful efficacy,   or  evidently  hurtful.
They are,
   6.  Strewing lime over putrid matters.  Dr. Dalzelle
 says, he once checked a bilious fever, by spreading twelve
 barrels of lime on a piece of marshy ground,  from whence
 the exhalations that produced it were derived*.  A mix-
 ture of quick lime and ashes  in water, when thrown into
 a privy, discharges from it a  large  quantity of offensive
 air, and leaves, it  afterwards without a smell.  As this
 foul  air is discharged into the atmosphere, it has been
              * Sur let Maladies desCUtnati ChaucU. 
132
ON  THE MEANS OF PREVENTING
doubted whether the lime and ashes should be  used for
that purpose, after a malignant fever  had made its  ap-
pearance.
   7. Mr. Quiton Morveau has lately  proposed  the  mu-
riatic gas as a means of destroying miasmata.   However
effectual it may be in destroy ing the volatile  and foul
excretions which are discharged from  the human body in
confined situations, as in filthy jails, hospitals, and ships;
it is not calculated to oppose the seeds of a disease which
exists in the atmosphere, and which are diffused over a
large extent of city or country.   Mr. Morveau  ascribes
great virtues to it,  in  checking the malignant  fever in
Cadiz, in 1801, but from the time at which it was used,
being late in the autumn, there is more reason to believe
it had run its ordinary course, or that it  was destroyed
by cold weather,
   8, The explosion of gunpowder has been recommended
for checking pestilential diseases.  Mr. Quiton  Morveau
says, it destroys the offensive odour of putrid exhalations,
but does not act  upon the fevers produced by them.
   9. Washing the  floors of  houses  with a solution of
alkaline salts in water, has been  recommended by  Dr.
Mitchell,  as an antidote to malignant fevers.  As yet,  I
believe, there are no fiicts which establish the efficacy of
the practice,  when they are produced by exhalations
from decayed vegetable and animal substances  in a  pu-
trid state.
   10, Large fires have sometimes been  made  in cities,
jn order to destroy the miasmata  of pestilential disease.
They were obviously hurtful in the plague of London, in
the year 1665.   Di\ Hodges, who relates  this fact, says,
" Heaven wept for  the mistake of kindling  them,  and
mercifully put  them out, with showers ol  rain."
   I cannot conclude  this head, without  lamenting the
want of laws in all our states, to compel physicians to
make public the first cases of malignant fever that come
under their notice.  The cry of fire is not  more  useful to
save a city from destruction, than the early knov ledge of
such cases would be to save it from the ravages  of pesti-
lential and mortal epidemics.  Hundreds of instances have
occurred in all ages and countries, in which  they might 
         SUMMER AND AUTUMNAL DISEASE.    ,133

have been stifled  in their birth, by the means that have
been mentioned, had  this practice  been adopted.  But
when, and where,  will science, humanity, and  govern-
ment first combine to accomplish this salutary purpose?
Most of  our histories of mortal epidemics abound with
facts which show a contrary disposition and  conduct in
physicians, rulers, and the people.   I shall mention  one
of these facts only, to show how far we must travel over
mountains of prejudice and error, before we shall witness
that desirable event.   It  is  extracted  from  the  second
volume of the Life of the late Empress of Russia.  " The
Russian army, (sa\ s the  biographer,) after defeating the
Turks, on  entering their territories were met  by  the.
plague, and brought it to their country, where the folly of
several of their generals contributed to its propagation, as
if they thought  by a military word of command to alter
the nature of things.  Lieutenant-general Stoffeln, at Yas-
sy, where the pestilence raged in the winter of 1770, is-
sued peremptory orders that its name should not be pro-
nounced; even he obliged the physicians and surgeons to
draw up a declaration in writing, that it was only a spoU
ted fever.  One honest surgeon of the  name of Kluge
refused to sign it.  In this manner the season of preven-
tion was neglected.   Several thousand Russian soldiers
were by  this means carried  off.  The men  fell dead upon
the road in heaps.  The  number of burghers that died
Was never known, as they had run into the country, and
into the forests.   At length the havoc of death   reached
the general's own people: he remained true to his persua-
sion, left the town, and went into the more perilous camp.
But his intrepidity availed  him nothing; he died of the
plague in July,  1771."*
   III. Let us now consider, in the last place, the means
 of exterminating malignant and other forms of  the sum-
 mer and autumnal  disease, by  removing their causes*
 These means are,
   1.  The removal or destruction of all those putrid mat-
 ters formerly enumerated, which are capable of produ-
 cing  fevers.  Many of  the  institutions of the  Jewish

  • The above disease appears to have been the camp fever, the origin and
 character of which will be noticed in the next article. 
 134      ON THE MEANS OF PREVENTING

 nation, for this purpose, are worthy of our imitation.  The
 following verses contain a fund of useful knowledge upon
 this subject.—" Thou shalt have  a place  without the
 camp, whither thou shalt go forth abroad; and shalt have
 a paddle upon thy weapon, and  it  shall be when  thou
 wilt ease thyself abroad,  thou shalt dig therewith, and
 shalt turn back, and cover that which cometh from  thee;
 for the Lord thy God walketh in the midst of thy camp
 to deliver thee, therefore shall he see no unclean thing in
 thee, and turn away from thee."   Deuteronomy, chapter
 xxiii. verses 12, 13; and 14.  " But the flesh of the bul-
 lock, and his  skin  and his dung,  shalt thou burn  with
fire without the camp." Exodus, chapter xxix. verse 14.
 The advantages of thus burying and removing all putrid
 matters, and of burning such as were disposed to a speedy
 putrefaction, in a crowded camp, and in a warm climate,
 are very obvious.  Their benefits have often been realized
 in  other countries. The United  provinces of Holland
 hold their exemption from the plague, only by the tenor
 of their cleanliness.  In the character given by Luther of
 Pope Julius, he says, " he kept  the streets  of Rome  so
 clean and sweet, that there were no plagues nor sickness
 during his time."   The city of  Oxford was prepared to
 afford an asylum to the royal family of Great-Britain  from
 the plague,  when it ravaged London, and other parts of
 England, in the year 1665, only in consequence of its
 having been cleaned, some years before, by the Bishop of
 Winchester.  In  a manuscript  account  of  the  life  of
 Doctor,  afterwards Governor  Colden,  of New-York,
 there is the following fact. It was first communicated to
 the public in the daily  gazette of the capital of that state,
 on  the 30th of October, 1799. " A malignant fever hav-
 ing raged with exceeding violence  for two summers suc-
 cessively  in the city of  New-York, about forty years
 ago, he communicated his thoughts to the public, on the
 most probable cure of the  calamity.   He  published a
 little treatise on the occasion, in which he collected the
 sentiments of the  best authority, on the  bad effects  of
 stagnating waters, moist air, damp cellars, filthy shores,
 and dirty streets.  He showed how much these nuisances
 prevailed in many parts of the city,  and pointed out the 
SUMMER AND AUTUMNAL DISEASE.     135
remedies.   The corporation of the city voted him their
thanks, adopted his reasoning, and established a plan for
draining and cleaning the city, which was attended with
the most happy effects." The advantages of burning offal
matters, capable by putrefaction of producing fevers, has
been demonstrated by those housekeepers, who, instead
of collecting the entrails of fish and  poultry, and the
parings  and skins of  vegetables, in  barrels, instantly
throw them into their kitchen fires.  The families of such
persons are generally healthy.
  2. In the  construction of cities, narrow  streets  and
alleys should be carefully avoided.  Deep lots should be
reserved for yards and  gardens for all the houses,  and
subterraneous passages should be dug to convey,  when
practicable, to running water, the contents of privies, and
the foul water of  kitchens.   In cities that are wholly
Supplied with fresh water by  pipes  from neighbouring
springs or rivers, all the evils from privies might be pre-
vented by digging them so deep as to connect them with
water.    Great advantages,  it has been suggested, would
arise in the  construction  of cities,  from leaving open
squares, equal in number  and size to those which are
covered  with houses.   The light and dark squares of a
chequer-board might serve as models for the execution of
such a  plan.   The city of London,  which  had been
afflicted nearly every year for above half a century by the
plague, has never been  visited  by it since the year  1666.
In that memorable year, while  the inhabitants were vent-
ing their execrations upon a harmless bale of silks  im-
ported  from Holland, as the vehicle of the seeds of their
late mortal epidemic, Heaven kindly pointed  out,  and
removed its cause, by permitting a fire to destroy whole
streets and lanes of small wooden buildings, which had
been the reservoirs of filth for centuries, and thereby the
sources of all the plagues of that city.*  Those streets and
lanes were to London, what Water-street and  Farmer's-
row are  to Philadelphia, Fell's-point  to Baltimore, the

  * A proposal was made to replace the houses that had been burnt, by sim-
ilar buildings, and upon the same space of ground.  Sir Christopher Wren op.
posed it, ami with the following argument; " Hy so doing;, you will show you
have not de em * J the late fire!'* 
136      ON THE MEANS OF  PREVENTING

slips and docks to New-York,  and Water-street to the
town of Norfolk.
  3. Where the different forms of summer and autumnal
disease arise from marsh exhalations, they should be de-
stroyed by drains, byT wells communicating with  their
subterraneous springs, or by cultivating upon them cer-
tain grasses, which form a kind  of mat over the soil, and,
when none of these modes of destroying them is practi-
cable, by overflowing them with water.
  I have  met with  many  excellent quotations  from a
work upon this part of our subject,  by  Tozzetti, an
Italian physician, from which,  I  have no doubt, much
useful information might be obtained. The Rev. Thomas
Hall,  to whom  I made an unsuccessful  application for
this work,  speaks of it, in his answer to my letter, in the
following terms. "It is in such high estimation that the late
emperor Leopold, when grand duke of Tuscany, caused it
to be re-printed at his own expense, and presented it to his
friends.  The conequence of this was, it influenced the
owners of low marshy grounds, in the neighbourhood of
the river Arno, to drain and cultivate them, and  thereby
rendered the abode of noxious air, and malignant fevers,
a terrestrial paradise."
  4. The  summer and autumnal diseases of our country
have often followed the erection of mill-dams. They may
easily be obviated by  surrounding  those  receptacles of
water with trees, which prevent the sun's acting upon
their shores, so as to exhale miasmata from them. Trees
planted upon the sides of creeks and rivers, near a house,
serve the same salutary purpose.
  5. It has often been observed, that families enjoy good
health,  for many years, in the swamps of Delaware and
North-Carolina, while they are  in their natural state, but
that sickness always follows the action of the rays of the
sun upon the moist surface of the  earth, after they are
cleared.  For this reason, the cultivation of a country
should always follow the cutting down of its timber, in or-
der to prevent the new ground  becoming, by its exhala-
tions, a source of disease.
  6.  In commercial cities, no  vessel that arrives with a
cargo of putrescent articles should ever  be suffered to 
        SUMMER AND AUTUMNAL DISEASE.      137

approach a wharf, before  the air that has been confined in
her hold has been discharged.   The same  thing should
be done after the  arrival of a vessel from a distant or
hot country,  though her  cargo be  not capable of putre-
faction, for air acquires a morbid quality by stagnating
contiguous to wood, under circumstances formerly men-
tioned.
  All these modes of removing the causes  of malignant
and yellow fevers, and of promoting strict and universal
cleanliness, are of more  consequence in the middle and
northern states of America, than in countries uniformly
warm, inasmuch as the disease maybe taken as often as
our inhabitants are exposed to its sources.   In the West-
Indies,  a second attack of the yellow fever is prevented
by the insensibility induced upon the system, by its being
constantly exposed to the impressions of heat and exha-
lation.  After a seasoning,  as  it is called, or a residence
of two or three years in those islands, the miasmata affect
the old settlers,  as they do the natives, only with mild
remittents. Nearly the same thing takes place at Madras,
in the East-Indies, where Dr. Clark  says,  the exhala-
tions which bring on  bilious fevers, colic,  cholera, and
spasmodic affections in new comers, produce a puking in
the morning, only in old residents.  But very different is
the condition of the inhabitants of  the middle and north-
ern states of  America,, in whom the winters prevent the
acquisition of habits of insensibility to the heat and exha-
lations  of the previous summers, and  thus  place them
every year in the condition of new comers in the West
and East-Indies, or  of  persons who have spent two or
three  years  in  a cold climate.  This  circumstance in-
creases the danger of depopulation from our malignant
epidemics, and should produce corresponding exertions
to prevent them.
  In enumerating the various means of preventing and
exterminating the  malignant forms of fever,  it  may ap-
pear strange  that I have said  nothing of the efficacy of
quarantines for that purpose.  Did I believe  these pages
would  be read only  by  the citi2ens of Pennsylvania, I
would do homage to their  prejudices,  by passing over
this subject by a respectful and melancholy silence; but as
   VOL. iv.                s 
138     ON THE MEANS OF PREVENTING

it is probable they will fall into the hands of physicians and
citizens of other states, I feel myself under an obligation
to declare,  that I believe quarantines of no efficacy in pre-
venting the yellow fever, in any other way than by exclu-
ding the unwholesome air that is generated in the holds
of ships, which may be done  as easily in a single day, as
in weeks or months.  They originated in error, and have
been  keep up  by a supine and traditional faith in the
opinions and conduct of our ancestors in medicine.   Mil-
lions .of dollars have been wasted by them.   From their
influence,  the commerce, agriculture,  and manufactures
of our country have suffered for many years.  But this
is not all.   Thousands of lives have been sacrificed, by
that faith in their efficacy, which has led to the neglect of
domestic cleanliness.    Distressing as these evils are,
still greater have originated from them;  for  a belief in
the contagious nature  of the yellow fever, which  is so
solemnly enforced by the execution of quarantine laws,
has demoralized our citizens.   It has, in many instances,
extinguished friendship,  annihilated religion,  and viola-
ted the sacraments of nature, by resisting even the loud
and vehement cries of filial and parental blood.
   While I thus deny  the yellow fever to be the offspring
of  a  specific  contagion,  and of  course  incapable  of
being imported so as to become an  epidemic in any
country, I shall admit presently,  that the excretions of a
patient in this disease  may, by confinement, become so
acrid as to produce,  under circumstances  to be men-
tioned hereafter, a similar disease, in a person, but from
this person it cannot be  communicated, if he possess
only the common advantages of pure air and cleanliness.
To enforce a quarantine law, therefore, under such a con-
tingent circumstance, and at  the expense of such a pro-
fusion of blessings as  have been mentioned,  is to imi-
tate the conduct of a man, who, in attempting to kill a
fly upon his child's forehead,  knocked out his brains.
   From the detail that has been given of the sources  of
malignant  fevers, and of the means of preventing them,
it is evident that they ck> not exist by an unchangeable
law.of nature,  and that  Heaven  has surrendered every
part of the globe to man, in a state capable of being in- 
        SUMMER AND AUTUMNAL DISEASE.  '   139

habited, and enjoyed.   The facts that have  been men-
tioned show farther, the connection  of health and lon-
gevity, with the reason and labour of man.
  To every natural evil the  Author of Nature has kindly
prepared  an antidote.   Pestilential fevers furnish no'ex-
ception to this remark.   The means  of preventing them
are as much under the power of human reason and in-
dustry, as the means of preventing the evils of lightning
and common fire.   I  am so satisfied of the truth of this
opinion,  that I look for the time when our courts of law
shall punish cities and villages,  for permitting any of the
sources of bilious and malignant  fevers to exist within
their jurisdiction.
   I have  repeatedly  asserted  the yellow fever of the
United States not to be contagious.  I shall now mention
the proofs of that assertion,  and endeavour to explain
instances of  its supposed  contagiousness  upon other
principles. 
PS . 
        FACTS,





     INTENDEn TO PROVE





THE YELLOW FEVER





  NOT TO BE CONTAGIOUS.
/ 
 
FACTS, &c.
     WHEN fevers are communicated from one  person
to another, it is  always in one of the following ways.
1. By secreted matters.   2. By excreted matters.   The
small-por and measles are communicated  in the former
way; the jail, or, as it is sometimes called, the ship, or
hospital fever, is communicated only  by  means  of the
excretions of  the body.   The perspiration, by acquiring
a  morbid and irritating quality more  readily than any
other excretion, in consequence  of its stagnation and con-
finement to the body in a tedious jail fever, is the princi-
pal means of its propagation.   The  perspiration* is,
moreover, predisposed to acquire this morbid and  acrid
quality by the filthiness, scanty, or bad aliment, and de-
pression  of mind, which generally precede that fever.  It
is  confined to sailors, passengers, soldiers, prisoners, and
patients,  in foul and crouded ships, tents, jails, and hos-
pitals, and to poor people who live  in small, damp, and
confined  houses.  It prevails chiefly  in cool  and cold
weather,  but is  never epidemic; for  the excreted  mat-
ters which  produce the  fever do not float in the external
atmosphere, nor are they communicated, so as to produce
disease,  more than a few feet from the persons who ex-
hale them.  They are sometimes  communicated by means
of the clothes  which have  been  worn  by  the  sick, and
there have  been instances  in  which the fever has been
produced by persons who had not been  confined  by it,
but who  had been previously exposed  to all the causes
which generate it.   It has been but  little known in the
United States since the  revolutionary war,  at  which
time it prevailed with great mortality  in the hospitals and
camps of the American army\   It has now and then ap-
peared in ships that were crowded with passengers from
 * The deleterious nature of this fluid, and its disposition to create dis-
ease, under the above circumstances, has been happily illustrated  by Dr.
Mitchill, in  an ingenious letter to Dr. Duncan, of Edinburgh, published in
the fourth volume of the Annals of Medicine. 
144     YELLOW FEVER NOT CONTAGIOUS.

different parts of Europe.  It is  a  common  disease in
the manufacturing towns of Great-Britain, where it has
been  the subject of several  valuable publications, par-
ticularly  by  Dr. Smith, and Dr.  John Hunter.   Drf.
Haygarth has likewise written upon it, but he has unfor-
tunately confounded it with the West-India and Ameri-
can yellow fever, which differs from it in prevailing, chiefly
in warm  climates and seasons; in being the offspring of •
dead and putrid vegetable and animal matters; in affect-
ing chiefly young and robust habits;  in being generally
accompanied with a diseased state of the stomach, and
an obstruction  or preternatural secretion and excretion
of bile:  in terminating,  most commonly,  within  seven
days; in  becoming epidemic only  by means of an im-
pure atmosphere; and in not furnishing ordinarily those
excretions which, when received into other bodies,  re-
produce the same disease.
   I have been compelled to employ this tedious descrip-
tion erf two forms of fever, widely  different  from each
other in their causes, symptoms, and duration, from the
want  of  two words which  shall  designate them.  Dr.
Miller has boldly and ingeniously  proposed  to remedy
this deficiency  in our  language,  by  calling  the former
idio-miasmatic, and the latter koino-miasmatio fevers,
thereby denoting their private ox personal and their public
or common origin.*  My best wishes attend the  adop-
tion of those terms!
   I return to remark, that the yellow fever  is not conta-
gious in  its  simple state, and that it spreads exclusively
by means of exhalations from putrid matters, which are
diffused in the air.  This is evident from the following
considerations:
   1.  It does not spread by contagion in the West-Indies*
This  has been proved in the most satisfactory manner by.
Drs.  Hillary, Huck, Hunter, Hector, M'Lean, Clark,
Jackson, Borland, Pinckard, and Scott.   Dr. Chisholm
stands alone, among modern physicians, in maintaining a
contrary  opinion.   It would be easy to prove, from many
passages in  the late edition  of the  doctor's learned and
instructive volumes, that he has been mistaken; and that
             • Alodical Repository, hexade ii. vol. i. 
          YELLOW FEVER NOT CONTAGIOUS,     145

 the disease was an endemic of every island  in which he
 supposed it to be derived  from  contagion.   A just idea
 of the great incorrectness of all  his statements, in favour
 of his opinion,  may be formed  from the letter of J. F.
 Eckard, Esq. Danish consul,  in Philadelphia, to Dr.
 James Mease, published in u late number of the New-
 York Medical Repository.*
   2.  The  yellow fever does not spread in the  country,
 when carried  thither from  the cities of the United btates.
   3.  It does not spread in yellow fever  hospitals, when
 they are situated beyond the influence of the impure air
 in which it  is  generated.
   4.  It does  not spread in cities (as will appear hereaf-
 ter) from any specific  matter emitted from the bodies of
 sick people.
   5.  It generally' requires  the co-operation  of an  exci-
 ting cause, with miasmata, to produce it.—This is never
 the case with diseases which are universally acknow-
 ledged to be contagious.
   6.  It is not propagated by the artificial means which
 propagate contagious  diseases.   Dr.  Ffirth  inoculated
 himself above twenty times, in different parts of his body,
 with the black matter discharged from the  stomach of
 patients in the yrellow  fever, and several  times with the
 serum of the  blood, and the saliva of patients  ill with
 that disease, without being infected by them;  nor was
 he indisposed  after swallowing half an ounce  of the black
 matter recently ejected from the  stomach, nor by expos-
 ing himself  to the vapour which was produced by throw-
 ing a quantity of that  matter upon iron  heated over a
 fire.f
   To the first four of these assertions there are  some
 seeming exceptions in favour of the propagation of this
 fever  by contagion.  I shall briefly mention them, and
endeavour to explain them  upon other principles.
   The circumstances which seem to favour the commu-
nication of the yellow fever from  one person  to another,

  • For February, March, and April, 1804.
  J Inaugural  Dissertation on  Malignant  Fever* Sic*  published in June,
   4.
VOL. IV.
T 
14$      YELLOW FEVER NOT CONTAGIOUS.

by means of what has been supposed to be contagions, are
as follows:
  1. A patient being attended in a small, filthy, and close
room.   The excretions of the body, when thus accumu-
lated, undergo an additional putrefactive process, and ac-
quire the same properties as those putrid animal matters
which  are  known to produce malignant fevers.   I have
heard of two or three instances in which a fever was pro-
duced  by these means in the country,  remote from the
place where it originated, as well as from every external
source of putrid exhalation.   The plague is sometimes
propagated in this way in the low and  filthy huts which
compose the alleys and narrow streets of Cairo, Smyrna,
and  Constantinople.
  2. A person sleeping in the sheets, or upon a bed im-
pregnated with the sweats or other excretions, or  being
exposed to  the smell of the foul linen,  or other clothing
of persons who had the yellow fever.   The disease here,
as in the former case, is  communicated in the same way
as from any other putrid animal matters.   It was once
received in Philadelphia  from the effluvia of a chest of
unwashed clothes, which had belonged to one of our citi-
zens who had died with  it in Barbadoes;  but it extend-
ed no  farther in a large family,  than to the  person who
opened the chest.  I have  heard of  but two instances
more of its having been  propagated by these means in the
United States, in which case the disease perished with the
 unfortunate subjects of it.
   To the above  insulated cases of the  yellow fever being
 produced  by the clothing of persons who had died of it,
 I shall oppose a fact communicated to  me by Dr. Mease.
 While the doctor resided at the lazaretto, as inspector of
 sickly vessels, between  May, 1794, and the  same month
 in  1793, the clothing contained in the chests and  trunks
 of all  the  seamen and others, belonging to Philadelphia,
 who had died of the yellow fever in the West-Indies, or
 on  their passage home,  and the linen  of all  the persons
 who had been sent from the city to  the lazaretto with
 that disease, amounting in all to more  than one hundred,
 were opened, exposed to the air, and washed, by the fam- 
        YELLOW FEVER  NOT  CONTAGI-OUS.      147

ily of the steward of the hospital, and yet no one of them
contracted the least  indisposition from them.
  I am disposed to believe the  linen, or any other cloth-
ing of a person in good health that had  been strongly im-
pregnated with sweats, and afterwards suffered to putrefy
in a confined place, would be more apt to produce a yel-
low fever in a summer or autumnal month,  than the linen
of a person who had died of that disease, with the usual
absence of a moisture on the skin.   The changes which
the healthy  excretions by the pores undergo by pUtrefac*
tion, may easily be conceived,  by recollecting the offen-
sive smell which a pocket handkerchief acquires that has
been used for two or three days to wipe away the sweat
of the face and hands in warm weather.*
  3. The protraction of a yellow fever to such a period
astodispose it to  assume the symptoms, and to generate
the peculiar and highly  volatilised exhalation  from the
pores of the skin which takes place in the jail fever.   I am
happy in  finding I am not the author of this opinion.  Sir
John Pringle, Dr. Monro, and Dr. Hillary, speak of a con-
tagious fever produced by the combined action of marsh
and human miasmata. The first of those physicians sup-
poses the Hungarian bilious fever, which prevailed over
the continent of Europe in the  seventeenth century, was
sometimes  propagated  in  this way, as well as by marsh
and other putrid exhalations.   Dr. Richard Pearson,  in
his observations upon the  bilious fevers which prevailed
in the neighbourhood of Pirmingham, in England, in the
years  1797,  1798,  and 1799, has the following remark:
"In its first stage, this fever did not  appear to be con-
tagious, but it evidently  was so after the eleventh and
fourteenth day, when the  typhoid state was inducedf."
As this protracted state  of bilious fever rarely occurs  in
our country, it has  seldom been  communicated in  this
way.
  It is not  peculiar,  I believe,  to a bilious and yellow
fever, when much protracted beyond its ordinary duration
to put on the symptoms of the jail fever.  The same ap-
pearances occur in the pleurisy,  and in  other, of what Dr.
  • See Van Sweitcn on Epidemic Diseases, Aphorism 1408.
  t Page 13. 
148
YELLOW FEVER NOT CONTAGIOUS.
Sydenham calls intercurrent fevers, all of which I have
no doubt, under certain circumstances of filth, confine-
ment, and long duration,  would product a fever in per-
sons who were exposed to it.   This fever, if the weather
were  cold, would probably put on inflammatory symp*.
toms, and be added, in our  nosologies, to the class of
contagious diseases.                                r
  From the necessary  influence of time,  in thus render-
ing fevers of all kinds now and then  contagious by ex-
cretion, it follows, that the yellow fever, when of its usual
short duration, is incapable of generating that excretion,
and that, instead of being considered as the only form of
bilious fever that  possesses a power of propagating itself,
it should be considered as the only  one that  is devoid
of it.
  4. Miasmata, whether from marshes, or other external
sources, acting upon a system previously impregnated
with the excreted matters  which produce the jail or ship
fever.  Mr. Lempriere  informs us, that he saw what were
supposed to be cases of yellow fever communicated by
some sailors who brought  the seeds of the ship fever with
them to the island of Jamaica.  The fevers which affected
most of the crews of the Hussar  frigate, mentioned by
Dr. Trotter*,  and of the Busbridge Indiaman,  described
by  Mr. Brycef,  appear to  have  been the effect of the
combined operations of foul air in those ships, and human
excretions, upon their systems.  The disease was barely
tinged with bilious symptoms, and hence the facility with
which it was cured, for the jail fever more readily yields
to medicine than the yellow fever.   The former was pro-
bably excited  by  some latent exhalation from dead mat-
ters in the holds of the  ships, and hence we find it ceased
on short*, where it was  deprived of its exciting cause.  It
is true, great pains were taken to clean the hold and decks
of the Busbridge,  but there are foul matters which ad-
here to the timbers of ships, and which, according to
Dr. Lind, are sometimes generated by those timbers when
new, that are not to be destroyed by any of the common
means employed for that purpose.    Of this Dr. Kollcck
has furnished us with  a most satisfactory proof, in his
  • Medicina Nautica, p. 360.     f Annals of Medicine, vol. i. p« 116> 
YELLOW FEVER NOT CONTAGIOUS.
149
history of the yellow fever  which prevailed on board of
the frigate General Greene, on her voyage to the Havanna,
in the year 1799.   "The air in the hold of the  vessels
(says the doctor) was so contaminated, as to extinguish
lights immediately, and candles in the cockpit were al-
most as useless from the same cause.   The fish  were
thrown overboard,  and the decks washed and  scoured,
the ventilator and wind sails put in  motion,  and every
measure of purification adopted that their situation  al-
lowed; notwithstanding these precautions disease invaded
Us.  The men were unceasing in their exertions to purify
the ship; washing, scouring with vinegar, burning pow-
der and vinegar, old junk, and sulphur, added to constant
ventilation,  proved unequal even to the amelioration of
their calamities,  while they were in the latitude of great
heat.  After the removal of the sick,  the ship was dis-
burdened of her stores, ballast, &c.  cleansed and white-
washed throughout; still new  cases  occurred for nearly
two  months.   >ome days, two,  three, or four were sent
off to the hospital, which would seem to indicate  the re-
tention of some portion of this noxious principle, which
was  lodged beyond the reach of theMeansing process."
That this noxious principle of matter existed in the  ship,
and not in the bodies of the crew, is  evident from its not
having been  communicated, in  a single instance,  by a
hundred of them who were sent to an hospital on Rhode-
Island, notwithstanding an intercourse sufficient to propa-
gate it was necessarily kept up with the inhabitants. Even
their nurses did  not take it.*
   5. A fifth  instance in  which contagion has been sup-
posed to  take place in the yellow fever is, where  the ex-
halation from the excretions of a patient in that disease
acts as an exciting cause, in persons previously  impreg-
nated with the marsh, or  other external miasmata, \\ hich
produce  it.   The activity  of this exhalation, even when
it is attended with  no smell, is so  great,  as to induce
•sickness,  head-ach, vertigo, and fainting.   It is not pe-
culiar to the exhalations  from  such patients  to  produce
morbid effects upon persons who visit them.   The odour
emitted by persons in the confluent  small-pox has  been
              Medical Repository, vol. iv. No. 1. 
 150      YELLOW FEVER NOT  CONTAGIOUS.

 known to produce the same symptoms together with a
 subsequent fever and apthous sore throat.  This has been
 remarked long ago by  Dr.  Lind, and latterly by Dr.
 Willan, in his Reports of the diseases of London.* That
 the yellow fever is often excited in this way, without the
 intervention of a supposed specific contagion, I infer from
 its sometimes spreading through whole families, who have
 breathed the  same impure atmosphere  with the  person
 first infected by the fever.  This is more especially the
 case where the impression made by the exhalation from
 the sick person is assisted by fear, fatigue, or anxiety  of
 mind in other branches of the  family.   In favour of this
 mode of exciting  the yellow fever, Dr. Otto communi-
 cated to me the following fact.  In the autumn of the year
 1798,  it previled  upon the shores of  the Delaware,  in
 Gloucester county, in New-Jersey.  A mild remittent
 prevailed at the same time on high grounds, a few miles
 from the river.   During  this time, the Doctor observed,
 if a |>erson who had inhaied the seeds of the yellow fever
 in Philadelphia afterwards came into a family  near the
 river, the same disease appeared in several  instances  in
 one or more  branches of that family; but where persons
 brought the fever  from the city, and went into a  family
 on the high grounds, where the mild remittents prevailed,
 there was not a single instance of a yellow  fever  being
 excited by them in any of its  members.   This  fact  is
 important, and of  extensive application.   It places the
 stimulus from the breath, or other exhalations of persons
 affected by the yellow fever, upon a footing  with intem-
 perance,  fatigue,  heat,  and all the common  exciting
 causes of the disease; none of whicht  it is well known,
 can produce it, except in persons who  have previously
 inhaled the putrid  miasmata, which in all countries are its
only remote cause.  The  city of Philadelphia has furnish-
 ed, in all our yellow fever years, many additional  proofs
 of the correctness of Dr.  Otto's remark.  In the months
of July and August, when miasmata are generally local,
and float chiefly near to their hot beds, the docks and holds
of sliips, persons who are affected by these miasmata, andi
 sicken in other parts of the city,  never communicate the
                   * Page 13 and 113. 
YELLOW FEVER NOT CONTAGIOUS.
151
disease; but after the  less prepared and heterogeneous
filth of our whole city has been acted on by an autumnal,
as well as summer sun, so as to emit pestilential exhala-
tions in all our streets  and alleys, the fever is now and
then excited in the manner that  has been mentioned by
a single person in a whole family.   The  common  inter-
mittents of the southern  states  are  often excited in the
same way, without being suspected  of spreading by con-
tagion.   Even the jail or hospital fever is vindicated by
Dr. Hunter from the highly contagious nature which has
been ascribed to it, upon the same principle.  His words,
which are directly to  my purpose,  are as follows: " In
considering the extent and power of the contagion [mean-
ing of the jail or hospital fever,]  1 am not inclined to im-
pute to  this cause the  fevers  of all  those who are  taken
ill in one family after  the first, as they are all along ex-
posed to  the same vitiated air which occasions the first
fever.   In like manner, when a poor woman visits some
of her sick neighbours, and is taken ill herself,  and after-
wards some of her children,  I would not impute the dis-
ease to infection alone; she and  her family having pre-
viously lived in the  same kind of vitiated air which ori-
ginally  produced the fever.    If the cases in which the
infection meets with the poison  already  half formed be
excepted, the  disease in itself will be found to  be much
less infectious  dian has  been  commonly supposed.*"
By the modes of communicating the yellow  fever  which
have  been admitted, the  dvsenterv, and all  the milder
 forms of autumnal fevers, have  been occasionally propa-
 gated, and perhaps oftener than  the first-named disease,
 from their  being more apt to run  on to the  typhus or
 chronic state.   Of this I could adduce many proofs, not
 only from books, but from  my own observations;  but
 none of these diseases spread by contagion, or become
 epidemic from  that  cause in  any country.   A contrary
 opinion, I know, is held by Dr. Cleghorn, and Dr. Clarke*;
 but they have deceived themselves, as they formerly de-
 ceived me, by not  attending to the difference between
 secreted contagious  and  morbid excretions  from the
 body,  produced by the causes which have been enume-
              * Medical  Transactions, vol. iii. p. 351. 
152
YELLOW FEVER NOT CONTAGIOUS.
 rated, and which are rare and accidental concomitants of
 bilious or summer diseases.
   6. The last instance of supposed contagiousness of the
 yellow fever is said to arise from the effluvia of a putrid
 body that has  died  of that disease.   The effluvia in  this
 case act either as the putrefied excretions mentioned under
 the  first  head, or as  an exciting cause upon miasmata,
 previously received into the system.  A dead body, in a
 State of putrefaction from any  other disease, would pro-
 duce, under the same circumstances of season and predis-
 position,  the same kind and degrees of fever.
   The similarity of the fever induced by the means that
 have been enumerated, with the fever from which it was
 derived,  has been supposed to favour the opinion  of its
 being communicated byr a specific contagion.  But let it
 be recolleoted  that the yellow fever is at the time of its
 being supposed to be thus received, the reigning epidemic,
 and  that  irritants of all kinds necessarily  produce that
 disease. The morbid sweats which now and then produce
 an intermitting fever, and the alvine excretions which oc-
 casionally produce a dysentery, act only by exciting mor-
 bid actions in the system, which  conform in their symp-
 toms to an immutable and universal law of epidemics. It
 is only when those two diseases generally prevail, that they
 seem to produce each other.
   Thus have  I explained all the supposed cases of the
 contagiousness of the yellow fever.   To infer from  the
 solitary instances of it thus excited,  is to reason as incor-
 rectly as to say the small-pox is not contagious, because
 we now and then meet with persons who cannot be infect-
 ed by it.
   From the explanation that has been given of the instan-
 ces in which the yellow fever has been supposed to spread
 by contagion, we are compelled to resort to certain  nox-
 ious matters in the atmosphere, as the exclusive causes of
the prevalence, not only  of that  fever, but (with a few
exceptions) of all other epidemic diseases.   It is true, we
are as yet ignorant of the precise nature of those matters in
the air which produce epidemics;  but their effects are as
certainly felt by the human body as the effects of heat, and
yet who knows the nature of that great and universal prin-
ciple of activity in our globe ? 
YELLOW FEVER NOT CONTACIGUS.
153
  That the  yellow fever is propagated by means of an
impure atmosphere, at all times, and in all places, I infer
from the following facts :
 ^ 1. It appears only in those climates and seasons of the
year in which heat, acting upon moist animal and vegeta-
ble  matters,  fills the air with their putrid  exhalations. A
vertical sun, pouring its beams for ages upon a dry soil;
and swamps, defended from the influence of the sun by
extensive forests, have not, in a single instance, produced
this disease.
  2. It is unknown in places  where a connection is not
perceptible between it, and marshes, uiill-ponds, docks,
gutters, sinks,  unventilated ships, and other sources of
noxious air.   The truth of this remark is established by
the testimonies of Dr.  Lind and Dr.  Chisholm, and by
many facts in Lempriere's  excellent History of the Dis-
eases  of Jamaica.   Dr. Davidson furnished me  with a
striking confirmation of their  remarks, in the following
extract from a letter, dated November 12th, 1794.  " I
have mentioned  (says the doctor) an instance of the re-
markable good health which the 66th regiment enjoyed at
St. Vincents for several years,  upon a high hill above the
town, removed from all exhalations,  and in a situation
kept at all times cool by the blowing of a constant trade
wind.  They did not lose, during eighteen months, abov6
two or three men (the regiment was completed to the
peace establishment,) and during eight years they lost but
two officers, one of whom, the quarter-master, resided
constantly in town, and died from overfatigue; the other
arrived very ill from Antigua, and died within a few days
afterwards."
   In the United States, no advocate for the specific nature
or importation of the yellow fever, has ever been able to
discover a single case of it beyond the  influence of an
atmosphere  rendered impure by putrid exhalations.
   It is no objection to the truth of this remark, that ma-
lignant bilious fevers sometimes appear  upon the sum*
mits of hills, while their declivities and  the vallies be-
low,  are  exempted  from them.  The miasmata, in all
these  cases, are  arrested  by those   heights, and  are
always .-to  be  traced to  putrefaction  and exhalation
 in  their neighbourhood.   Nor  is  it  any objection to.
    VOL.  IV. 
 154     YELLOW FEVER NOT CONTAGIOUS.

 the  indissoluble connection between putrid exhalations
 and the yellow fever, which has been mentioned, that the
 disease Idmetimes appears in places remote from the
 source of miasmata in time  and place.  The bilious pleu-
 risies, which occur in the winter and spring, after a sickly
 autumn, prove that they are retained in the body for many
 months, and although they are sometimes limited in their
 extent to a single house, and often to a village, a city, and
 the  banks of a creek  or river, yet they are now and then
 carried to a much greater distance.  Mr. Lempriere, in
 his valuable Observations upon the Diseases of the British
 Army in Jamaica, informs us, that Kingston is sometimes
 rendered sickly by exhalations from a lagoon, which lies
 nine miles to the eastward of that town.* The greater or
 less distance, to which miasmata are carried from the place
 where they are generated, appears to depend upon their
 quantity r upon the force and duration of currents of wind
 which act upon them,  and upon  their being more or
 less  opposed by rivers, woods, water,  houses, wells, or
 mountains.
   3. It is destroyed, like its fraternal diseases, the common
 bilious and intermitting fevers, by means of long-continued
 and  heavy rains.f When rains are heavy, but of short
 duration, they suspend it only in warm weather, but when
 they are succeeded by cold weather they destroy all the
forms, of bilious fever. The malignant tertians, described
by Dr. Cleghorn, always ceased about the autumnal equi-
nox; for at that time,  says the Doctor, "Rain falls in such
torrents as to tear up trees by the roots, carry away cattle,
break down fences, and do  considerable mischief  to the
 gardens and vineyards ; but, after a long and scorching
 summer, they are very acceptable and beneficial, for they
mitigate the excessive heat of the air, and give a check to
epidemical diseases."!  There are facts, however,  which
would seem to contradict the assertion that  miasmata are
suspended or destroyed by heavy rains.   Dr. Lind, in his
Treatise upon the Diseases of Hot Climates, mentions in-
stances in which they suddenly created fevers. It is pro-
bable, in these cases the rains may have had that effect, by

  • Vol. i. page 84.
  f Clarke on the Diseases of Long Voyages to Hot Climates, page US
  i Diseases of Minorca, p. 8. 
YELLOW FEVER
NOT CONTAGIOUS.
155
disturbing the pellicle which time often throws over the
surface of stagnating pools of water, and putrid matters on
dry land.  I was led to entertain this opinion  by a fact
mentioned in a letter I received from Dr. Davidson, dated
November 4th, 1794.  "Being ordered (says the doctor)
up to Barbadoes, last November, upon service, I found
that the  troops had suffered considerably by that formi-
dable scourge,  the yellow fever.   The season had  been
remarkably dry.   It was observed, a rainy season contri-
buted to make the season healthier, excepting at Constitu-
tion-Hill, where the sixth  regiment was stationed, and
where a heavy shower of  rain seldom failed to bring  back
the fever, after it had ceased for some time.  I found the
barrack,  where this regiment was, surrounded by a  pond
of brackish water, which being but imperfectly drained by
the continuance of the drought, the surface  was covered
with a green scum, which prevented the exhalation of
marshy putrefaction.   After a heavy shower of rain, this
scum was broken, and the  miasmata evolved,  and  acted
with  double force,  according to the time  of their se-
 cretion."
   4.  It  is completely  destroyed by frost.   As neither
rains  nor frosts act in sick  rooms, nor affect the bodies of
 sick  people, they must  annihilate  the disease by acting
 exclusively upon the atmosphere.  Very different in their
 nature are  the small-pox and measles, which are propa-
 gated by specific contagion.   They do not wait for the
 suns of July or August, nor do they require an impure
 atmosphere, or an exciting cause, to give them activity.
 They spread in  the winter and spring, as well as in the
 summer and autumnal months: wet and dry weather do
 not arrest their progress, and frost,  (so fatal  to the yellow
 fever,) by rendering it necessary to exclude cold air from
 sick  rooms, increases the  force of their contagion, and
 thereby propagates them more certainly through a country.
   5. It  is likewise destroyed by intense heat, and high
 winds. The latter, we are sure, like heavy rains and  frost,
 do not produce that salutary effect by acting upon the
 bodies,  or in the rooms  of sick people.
   It is worthy of notice, that  while the activity of  mias-
 mata is  destroyed by cold, when it desends to frost; by
 heat, when it is so intense as to dry up all the sources  of 
156     YELLOW FEVER  NOT CONTAGIOUS.

putrid exhalation; by heavy rains, when they are succeed-
ed by cool Weather; and by high winds, when they  are
not succeed by warm  weather; they are rendered  more
active by cool, warm, and damp weather,  and by light
winds.   The influence of damp weather, in retaining and
propagating miasmata, will be readily admitted, by recol-
lecting how much  more easily hounds track their  prey,
and how much more extensively odours of all kinds per-
vade the atmosphere, when it is charged with moisture,
than in dry weather.
  It has been asked, if putrid matters produce malignant
bilious fevers in our cities, why do they not produce them
in Lisbon, and in several other of the filthieat cities in the
south of Europe? To this I answer, that filth and dirt are
two distinct things.   The  streets of a city may be very
dirty, that is covered with  mud composed of inoffensive
clay,  sand, or lime, and, at the same time, be perfectly
free from those filthy vegetable and animal matters which
by putrefaction, contaminate the air.  But admitting the
streets of those cities to abound with the filthy matters that
produce pestilential diseases in other countries, it is possi-
ble the exhalations from them may be so constant, and so
powerful, in their impressions upon the bodies of the in-
habitants, as to produce, from habit, no morbid effects, or
but feeble diseases, as was  remarked formerly, is the case
in the natives and old settlers in the East and West-Indies.
But if this explanation be not satisfactory, it may be re-
solved into a partial absence of an inflammatory consti-
tution of the air, which, I shall say presently, must concur
in producing pestilential diseases. Such deviations from
uniformity  in the works of Nature are universal. In the
present instances, they no more invalidate the general pro-
position Of malignant fevers being every where of domes-
tic  origin, than the  exemption of Ireland from venomous
reptiles, proves they are not generated in other countries,
or that the pleurisy and rheumatism are not the effects of
the alternate action  of  cold and heat upon the body,  be^
cause hundreds, who have  been exposed to them under
equal circumstances, have  not been affected by those dis*
eases.  There may  be other parts of the world in which
putrid matters do not produce bilious  malignant diseases
km the causes that have been mentioned, or from some 
         YELLOW FEVER NOT CONTAGIOUS.      157

onknown cause, but I am safe in repeating, there never
was a bilious epidemic yellow fever  that could  not be
traced to putrid exhalation.
  It has been asked, if the yellow fever be not imported,
why does it make its first appearance among sailors, and
near the docks and wharves of our cities?  I answer, this
is far from  being true.   The disease has as often appear-
ed first at a distance from the shores of our cities as near
them, but,  from its connection with a ship not being dis-
covered, it has been called by another name.  But where
the first cases of it occur in sailors, I believe the seeds of
it are always previously  received by them from our filthy
docks and wharves, or from the foul air which is dis-
charged with the cargoes of the ships in which they have
arrived, which seeds are readily excited in them  by hard
labour, or intemperance so as to produce the disease.
That this is the case, is  further evident from  its  appear-
ing in them, only in those months in which  the bilious
fever prevails in our cities.
   It has been asked further, why were not these bilious
malignant fevers more common  before the years  1791,
1792, and 1793? To this I answer,  by repeating what
was mentioned in another place*, that our climate has
been gradually undergoing a change.  The summers are
more alternated by hot and cool, and wet and dry weather,
than in former years.  The winters are likewise less uni-
formly cold.   Grass is two or three weeks later in the
spring in affording pasture to cattle than it was within the
memory of many thousand people.  Above all, the sum-
mer has encroached upon the  autumn,  and hence the
frequent accounts we read in our newspapers cf trees
blossoming, of full grown strawberries and  raspberries
being gathered,  and of cherries and apples, of a consi-
derable size, being seen in the months  of October and
November, in all the middle  states.  By means  of this
protraction of the heat of summer, more time is  given
for the generation of putrid exhalations, and possibly for
their greater concentration and activity in producing ma-
lignant bilious diseases.
   It has been asked again, why do  not the putrid mat-
ters which  produce the yellow fever in some years pro-
         • Account of the Climate of Pennsylvania, vol. i. 
158       YELLOW FEVER NOT CONTAGIOUS.
duce it every year?  This  question might be  answered
by asking two others.   1st. Why, if the yellow fever be
derived from the West-Indies, was it not imported every
year before 1791, and before the existence, or during the
feeble and partial operation of quarantine laws? It is no
answer to this question to  say, that a war is necessary  to
generate the disease  in the islands, for it exists in some
of them at all times, and the seasons of its prevalence in
our cities have, in many instances, had no connection with
war, nor with the presence of European armies in those
and other sickly parts ofyhe globe.   During  the seven
years revolutionary war It  was unknown as an  epidemic
in the United States, and yet sailors arrived  in all our
cities daily from sickly islands, in small and crowded ves-
sels, and sometimes covered with the rags they had worn
in the yellow fever, in British hospitals and jails.  I ask,
2dly, why does the dysentery (which is certainly a do-
mestic disease) rise  up in  our country, and spread sick-
ness and death through whole families and villages, and
disappear from the same places for fifteen or twenty years
afterwards?
   The want of uniformity in the exhalations of  our coun-
try in producing those diseases depends upon their being
combined  with  more or less heat or  moisture;  upon the
surface of the earth being  completely dry, or completely
covered with water,* upon different currents of winds,
or the total absence of wind; upon the  disproportion  of
the temperature  of the air  in the day and night; upon the
quantity of dew; upon the early or late appearance  of
warm or cold weather; and upon  the  predisposition  of
the body to disease,  derived from the quality of the ali-
ments of the season.  A similar want of uniformity in the
annual operations of our climate appears in the size and
quality of  grain, fruits, and vegetables of all kinds.

  • In the Account of the Yellow Fever of 1793, the different and opposite
pftects of a dry and rainy season in producing bilious fevers are mentioned
from Dr. Dazilles. In the autumn of 1804, I have elsewhere remarked, after
a svimmer in which there had fallen  an unusual quantity of rain, the bilious
fevers appeared chiefly on the high grounds in Pennsylvania, which were in a
state of moisture, while scarcely a case of them appeared in the neighbour-
hood of marshes, or low grounds, owing to their being so completely covered
with water, as to be incapable of generating, by putrefaction, the miasmata
which produce those forms of disease. 
        FELLOW FEVER NOT CONTACIOUS.       159

  But the greater violence and mortality of our bilious
fevers, than in former years, must be  sought for chiefly
in an inflammatory or malignant constitution of the at-
mosphere, the effects of which have been no less obvious
upon the small-pox, measles, and the  intercurrent fevers
of Dr. Sydenham, than they are upon the  summer and
autumnal disease that has been mentioned.
  This malignant state of the air has been noticed, under
different names, by all the writers upon epidemics, from
Hippocrates down to the present day.  It was ascribed,
by the venerable father  of physic, to  a  " divine some-
thing" in the atmosphere. Dr. Sydenham, whose works
abound with references to it,  supposes it to be  derived
from a mineral exhalation from the bowels  of the earth.
From numerous  other testimonies of  a belief in the in-
fluence of the insensible qualities of the air, altering the
character of epidemics, I shall select the following:
  "  It is certain (says Dr. Moseley) that diseases un-
dergo changes and revolutions.  Some  continue  for a
succession  of years,  and vanish when  they  have ex-
hausted the  temporary, but secret cause which  produced
them.   Others have appeared and disappeared suddenly;
and others have their periodical returns."
  The doctor ascribes a malignant fever among the dogs
in Jamaica (improperly called, from one of its symptoms,
hydrophobia,) to a change in the atmosphere, in the year
1783. It was said to have been imported,  but experience*
he says, proved the fact to be otherwise.*
  " This latent malignity in the atmosphere (says Baron
Vansweiten) is known only by its effects, and cannot
easily be reduced to any known  species of acrimony."
In another place he says, " It seems certain that this un-
known matter disposes all the humours to  a sudden and
bad putrefaction."!
  Dr. John Stedham has related many  facts, in his Essay
upon Insalutary Constitutions of the Air, which prove,
that  diseases are  influenced by a quality in it, which, he
says, " is productive of corruption," but which has hi-
therto eluded the researches of physicians. "|

  • Treatise upon Tropical Diseases, p. 4.1, 44.
  t Commentaries on Boeruaavc's Aphorisms, vol. v. p. 226, 230.
  t Page 135. 
160
YELLOW FEVER NOT CONTAGIOUS.
  Mr. Lempriere, after mentioning the unusual mortality
occasioned by the yellow fever, within the last five or six
years,  in the island of Jamaica,  ascribes it wholly  " to
that particular constitution of atmosphere upon which the
existence of epidemics, at one period rather than another,
depend."*
  Not only diseases bear testimony to a change in the
atmosphere, but the whole vegetable and animal creation
concur in it, proofs of which were mentioned in another
place.   Three things are remarkable with respect to this
inflammatory constitution of the air.
  1. It is sometimes of a local nature, and influences the
diseases of a city, or country, while adjoining cities and
countries are exempted from it.
  2. It much oftener pervades a great extent of country.
This was evident in the  years 1793  and 1794, in the
United States.   During the same years, the yellow fever
prevailed in most of the West-India islands.  Many of
the  epidemics mentioned by Dr.  Sims, in the first volume
of the Medical Memoirs, affected, in the same years, the
most remote parts of the continent of Europe. Even the
ocean partakes of a morbid constitution of its atmosphere,
and diseases at sea sympathise in violence with those of
the  land, at an immense distance from each other.  This
appears in a letter from  a surgeon, on  board a British
ship of war, to Mr. Gooch, published in the third volume
of his  Medical and  Surgical Observations.
  3. The predisposing state of the atmosphere to induce
malignant diseases continues for several years, under all
the  circ urn stances of wet and  dry, and  of hot and  cold
weather.  This will appear, from attending  to  the ac-
counts which have been given of the weather, in all the
years in which the yellow fever has prevailed in Philadel-
phia since 1792,f  The remark is confirmed by all the
records of  malignant epidemics.
  It is to no purpose to say, the presence of the peculiar
matter which constitutes an inflammatory or malignant
state of the air has not been detected by any chemical
agents.  The same thing has been justly said of the ex-
halations which produce the bilious intermitting, remit -
             • Vol. ii. p. 31.       t Vol. iii and iv. 
         YELLOW FEVER  NOT  CONTAGIOUS.     161

ting, and yellow fever.  No experiment that has yet been
made,  has discovered their presence in the  air.   The
eudiometor has been used in vain for this purpose.  In one
experiment made by Dr. Gattani, the air from a marsh
at the mouth of the river Tataline was found to be appa-
rently purer by two degrees than the air on a neighbour-
ing mountain, which  was 2880 feet higher than the sea.
The inhabitants of the mountain were notwithstanding
healthy, while those who lived in the neighbourhood of the
marsh was  annually afflicted with bilious and intermitting
fevers.*   The contagions of the small-pox and measles
consist  of matter, and yet who has ever discovered this
matter in the air?  We infer the existence of those remote
causes of disease in the  atmosphere only from their ef-
fects.  Of the existence of putrid exhalations in it, there
are  other evidences  besides bilious and yellow  fevers.
They are sometimes the objects of the sense of smelling.
We see them in the pale or  sallow complexions of the
inhabitants of the countries which generate them, and we
observe them occasionally  in the diseases of several do-
mestic animals.   The most frequent of these diseases are
inflammation, tubercles, and  ulcers in the liver.   Dr.
Cleghorn describes a diseased state of thatviscus in cat-
tle, in an unhealthy part of the island of Minorca.   Dr.
Grainger takes notice of several  morbid appearances  in
the livers of domestic animals in Holland, in the year
1743.   But the United States have furnished facts to il-
lustrate the truth of this remark.  Mr. James Wardrobe,
near Kichmond in Virginia, informed me, that in August,
1794, at a  time when bilious fevers were pravelent in his
neighbourhood, his  cattle  were  seized with a disease,
which, I said formerly, is known by the name of the yel-
low water,  and which appears to be a true yellow fever.
They were attacked  with  a  staggering.    Their eyes
were muddy, or  ferocious.   A costiveness  attended in
all  cases.   It killed in two days.  Fifty-two of his cat-
tle perished by it.  Upon opening the bodies  of several
of them,  he found  the  liver  swelled and  ulcerated.
The blood was dissolved in the veins.   In the bladder of
  • Alibert's Dissertation sur leg  Fievres Pcrnicieuses et  Attaxques Inter-
mittentes, p. 185.
  VOL. IV,             K 
162      YELLOW FEVER NOT CONTAGIOUS.

one of them,  he found thirteen pints of blood and water.
Similiar appearances were observed in the livers of sheep
in the neighbourhood of Cadiz, in the year 1799, during
the prevalence of the yellow fever in  that city.  They
were considered as such  unequivocal  marks of an un-
wholesome atmosphere among the ancients, that they ex-
amined the livers of domestic animals, in order to deter-
mine on the healthy or unhealthy situation of the spot on
which they wished to live.
   The advocates for the yellow  fever being a  specific
disease, and propagated only by contagion, will gain noth-
ing by denying an inflammatory constitution of the atmos-
phere (the cause of which is  unknown to us) to be ne-
cessary to raise common remittents to that grade in which
they become  malignant yellow fevers; for they are obliged
to have recourse to an unknown quality in the air, every
time they are called upon to account for  the disease pre-
vailing chiefly in our cities, and not spreading when it is
carried from them into the country.  The same reference
to an  occult quality in the air is  had by all  the writers
upon  the plague,  in accounting  for its  immediate and
total extinction,  when it is carried into a "foreign port.
   In  speaking of the influence of an inflammatory con-
stitution  of the atmosphere in raising common bilious, to
malignant yellow fevers,  I wish not to have it supposed,
that its concurrence is necessary to produce sporadic cases
of that,  or any  other  malignant  disease.  Strong ex-
citing causes, combined with highly volatilised and ac-
tive miasmata, I believe,  will produce a yellow fever at
any time.  I have seen one  or more such cases almost
every year since I settled in Philadelphia,  and particularly
when my business was confined chiefly  to that class  of
people who live  near the wharfs, and in the suburbs, and
who are still the first, and frequently the only victims of
the yellow fever.
   It has been said, exultingly, that the opinion of the im-
portation of the yellow fever is of great antiquity in our
country, and that it has lately been admitted by the most
respectable physicians in  Britain  and France, and  sanc-
tioned by the laws of several of the governments in Europe*
**ad antiquity, numbers,  rank, and power been just ar- 
YELLOW FEVER NOT
CONTAGIOUS'.
163
guments in favour of existing opinions, a thousand truths
would have perished in their birth, which have diffused
light  and happiness over every part  of  our globe.   In
favour of the ancient and general belief of the importation
of the yellow fever, there are several obvious reasons.
The idea is produced by a single act of the mind.  It re-
quires neither comparison nor reasoning to adopt it,  and
t herefore accords with the natural indolence of man.  It,
moreover, flatters his avarice and pride, by throwing the
origin of a mortal disease from his property and country.
The principle of thus  referring the origin of the evils of
life from ourselves to others,  is universal.  It began in
paradise, and has ever since been  an essential feature in
the character of our species.  It has constantly led in-
dividuals and nations to  consider loathsome and danger-
ous diseases as of foreign extraction. The venereal disease
and the leprosy  have no  native country, if we believe all
the authors who have written upon them.  Prosper Al-
pinus derives the plagues of  Cairo from  Syria, and the
physicians of Alexandria import them from  Smyrna or
Constantinople.  The yellow fever is said to  have been
first brought from Siam (where there are proofs it never
existed) to the West-Indies,  whence it is believed to be
imported into the cities of the United States. From them,
Frenchmen and Spaniards say it has been re-shipped, di-
rectly or indirectly, to St. Domingo, Havannah, Malaga,
Cadiz, and other parts of the world.   Weak and absurd
credulity!  the causes of the ferocious and mortal disease
which we thus thrust from our respective ports, like the
sin of Cain, "lie exclusively  at our own  doors."
   Lastly, it has  been asserted, if we admit the yellow fever
to be an indigenous disease of our cities, we shall destroy
their  commerce, and the value of property  in  them, by
disseminating a belief, that the cause of our  disease is
fixed in our climate, and that it is out of the power of
human means to remove it.   The reverse of this suppo-
sition is true.   If it be an imported disease, our case is
without a remedy; for if, with all the advantages of quar-
antine laws enforced by severe penalties, and executed in
the most despotic manner, the disease has existed annual-
ly, in most of our cities, as  an epidemic, or in sporadic 
164      YELLOW FEVER NOT CONTAGIOUS.
cases ever since the year 1791, it will be in  vain to ex*
pect, from similar measures, a future exemption from it.
Nothing but a belief in its domestic origin, and the adop.
tion of means founded upon that belief, can restore the
character of our climate, and save our commercial cities
from destruction.   Those means are cheap, practicable,
and certain.   They  have succeeded, as 1 shall say pre-
sently, in other countries.
   From  the account that  has been  given of the different
ways in which this disease  is communicated  from  one
person to another, and from the facts which  establish its
propagation exclusively through the medium of the at-
mosphere, when  it becomes epidemic,  we may explain
several things which belong to its history, that  are  inex-
plicable  upon the principle  of its specific contagion.
   1. We learn the reason why, in  some instances, the
fever does not spread from  a person who sickens or dies
at  sea, who had carried the seeds of it in his body from
a sickly  shore. It is because no febrile miasmata exists in
the bodies of the rest of the crew to be  excited into ac-
tion by any peculiar smell from the disease, or  by  fear
or fatigue, and because no  morbid  excretions are  gene-
rated by the  person who dies.  The fever which pre-
vailed on board the Nottingham  East-Indiaman, in the
year 1766, affected those forty  men only, who had slept
on shore on  the Island  of Joanna twenty days before.
Had the whole crew  been  on  shore,  the disease would
probably have affected them all and been ascribed to con-
tagion generated by the  first persons who were confined
by it.*  A  Danish ship, in the year 1768, sent twelve
of her crew on shore for water.   They were all seized
after their  return to the ship with a malignant fever, and
died without infecting any person on  board,  and  from
the same causes  which preserved the crew of the  Not-
tingham East-Indiaman. f
   2. We  learn the reason  why the disease sometimes
spreads through a whole ship's crew apparently  from one,
or more  affected persons.   It is either because they have
  * Observations  on the  Bilious Fevers usual in  voyages to the East.
Indies, by James Bidenach, M. D.  Medical Observations and  Inquiries,
vol. iv.
  f Clarke on the Diseases of Long Voyages to Hot Climates, p. 123,135. 
         YELLOW FEVER  NOT CONTAGIOUS.     165

been confined to small and close births by bad  weather,
or because the fever has been protracted 10 a typhus or
chronic state, or because the bodies of the whole crew
are impregnated with morbid miasmata, and thus predis-
posed to have the disease excited in the manner that has
been mentioned.  In the last way it was excited in most
of the  crew of the  United  States  frigate,  in the Dela-
ware, opposite  to the  city  of  Philadelphia, in the year
1797..  It appears to have  spread, from a similar cause,
from a few sailors, on board the Grenville  Indiaman,
after touching  at Batavia.  The whole crew had been
predisposed to the disease by inhaling the noxious air  of
that island.
   The  same reasons account for the fever expiring in  a
healthy village  or country; also for  its spreading when
carried to those towns  which are seated upon creeks or
rivers,  and in the neighbourhood of marsh exhalations;
It has uniformly perished in the high and healthy village
of Germantown,  when carried from  Philadelphia, and
has three times been  supposed, erroneously, to be con-
tagious near the muddy shores  of the  creeks which  flow
through Wilmington and Chester.
   3. From the facts that have  been mentioned, we are
taught to disbelieve the possibility of the disease being
imported in the masts  and sails of a ship, by a contagious
matter secreted by a  sailor who may  have sickened or
died on board her, on a passage from a West-India island.
The death in most of the cases  supposed to be imported,
in this way, occurs within a few days after the ship leaves
her  West-India port,  or within a few days  after her arri-
val.    In  the former  case, the  disease is  derived from
West-India miasmata; in the latter, it is derived, as was
before remarked, either from the foul air of the hold  of
the ship, or  of the dock or wharf to which the ship is
moored.
   Many other facts might  be adduced to show the yel-
low  fever not to be an imported disease.  It has often
prevailed among the Indians remote from the sea coast,
and  many hundred cases of it  have occurred since the
year 1793, on the inland  waters  of the United States,
from the Hudson and Susquehannah, to the rivers of the 
 166     YELLOW FEVER NOT CONTAGIOUS.

 Mississippi.  In houth America, Baron Humboldt assur-
 ed me,  it is every where  beiieved to be  an endemic of
 that country.
   These simple  and connected facts, in which  all the
 physicians in the United  States who  derive the yellow
 fever from domestic causes have  agreed,  will  receive
 fresh support by  comparing them with the different and
 contrary opinions of the physicians who maintain its im-
 portation.   Some of them have asserted  it to be a  spe-
 cific disease, and derived  it from the East and West-In-
 dies;  others derive   it from  Beulam, on  the coast of
 Africa;  a  third sect  have  called it a ship fever; a fourth
 have  abscribed  it to a mixture of imported contagion
 with the foul air of our cities;  while a fifth, who believe
 it to be imported in 1793, have supposed  it to be the
 offspring of a contagion  left by the disease of that year,
revived by  the heat of our summers, and disseminated,
ever since, through  the different cities of  our country.
The number of these opinions, clearly proves, that no
 one of diem is tenable.
  A belief in the non- contagiousness of the yellow fever,
or of its being incommunicable except in one of the five
ways that have been  mentioned, is calculated to produce
the following good effects:
  1.  It will deliver the states which have sea-ports from
four-fifths  of the expenses of  their present quarantine
laws  and lazarettoes.  A very small apparatus, in laws
and officers, would be sufficient to prevent the landing of
persons affected  by  the ship fever  in our cities,  and the
more dangerous practice of ships pouring streams of pes-
tilential air, from their  holds,  upon the  citizens who
live near the docks and wharves.
  2.  It will deliver our merchants from the losses incur-
red by  the delays of their ships,  by long and unneces-
sary quarantines.   It will,  moreover, tend to procure the
immediate  admission of our ships into  foreign ports, by
removing that belief  in the contagious  nature of the yel-
low fever,  which originated  in  our  country, and which
has been spread,  by  the public acts of our legislatures
 and boards of health, throughout the globe. 
         YELLOW  FEVER  NOT CONTAGIOUS.     167

  3. It will deliver our citizens from the danger to which
they are exposed, by spending the time of the quarantine,
on board of vessels in the neighbourhood of the marshes
which form the shores of the rivers or coasts of quaran-
tine roads.   This danger is much increased by idleness,
and by the vexation which  is excited, by sailors and pas-
sengers being detained, unnecessarily, fifteen  or  twenty
days from their business and friends.
  4. It will lead us to a  speedy removal of all the excre-
tions, and a constant ventilation of the rooms of patients
in the yellow fever, and  thereby to prevent the accumu-
lation, and further putrefaction of those exhalations which
may produce it.
  5. It is  calculated to  prevent the desertion  of patients-
in the yellow fever, by their friends and families,  and to
produce caution in them to prevent the excitement of the
desease in their own bodies, by means of low diet  and
gentle  physic, proportioned to the impurity  of the  air,
and to the  anxiety and fatigue to which they  are expos-
sed in attending the sick.
  6. It will put an end  to the cruel  practice of quieting
the groundless fears of  a whole neighbourhood,  by re-
moving the poor  who  are affected  by the fever, from
their houses, and conveying them,  half dead with dis-
ease and terror, to a solitary or crowded hospital, or of
nailing  a yellow  flag  upon  the  doors of others, or of
fixing a guard before them, all which have been prac-
tised in Philadelphia, not only without any good effect,
but to the great injury of the sick.
  7. By deriving the fever from  our own climate and at-
mosphere,  we shall be able to foresee its approach in the
increased violence  of common diseases, in the morbid
state of vegetation, in  the course of the winds, in the
diseases of  certain brute animals, and in the increase of
common, or the appearance of uncommon insects.
  8. A belief in  the non-contagiousness of the  yellow
fever, and its  general prevalence from putrid animal  and
vegetable matters only, is calculated to lead us to drain
or cover marshy grounds,  and to remove from our cities
nil the sources of impure air, whethqr they  exist in  tho, 
168      YELLOW FEVER NOT CONTAGIOUS.

holds of ships, in docks, gutters,  and  common  sew-
ers,  or  in  privies,  gardens, yards,  and cellars,  more
especially during the existence of the signs of a malignant
constitution of the air.   A fever, the same in its causes,
and simliar to it in many  of its symptoms, that is, the
plague, has been extirpated, by extraordinary degrees of
cleanliness, from the cities  of Holland, Great-Britain, and
several other parts of Europe.
  The reader will perceive, from these facts and reason-
ings, that I have relinquished  the  opinion  published in
my account of the yellow fever in the years 1793,  1794,
and  1797,  respecting its contagious nature.   I was mis-
led by  Dr. Lining, and several West-India writers, in
ascribing  a much greater  extent to the excreted matters
in producing the disease, than I have since discovered to
be correct, and by  Bianchi, Lind,  Clark, and Cleghorn,
in admitting  even the common bilious fever to be conta-
gious.   The reader will perceive, likewise, that I have
changed my opinion respecting one of the modes in which
the  plague is  propagated.  I once believed, upon the
authorities of travellers, physicians and schools of medi-
cine, that it was a highly contagious disease.   I am now
convinced  this is not the case;  but, from  the greater
number of people who were depressed and  debiliated by
poverty and famine, and who live in small and filthy huts*
in the cities of the east,  than in the citi es or the United
States.  I still believe it to be more frequently communi-
cated from an intercourse  with  sick people  by the mor-
bid excretions of the body, than the yellow fever is  in our
country.   For the change of my opinion upon this sub-
ject, I am indebted to Dr.  Caldwell's and Mr. Webster's
publications  upon  pestilential diseases, and to the travels
of Mariti  Sonnini into  Syria,  and  Egypt.    I reject,
of course,  with the contagious quality of the plague,
the idea of its  ever being  imported into any  country so
as to  become epidemic,  by  means  of a  knife-case,  a
piece of cotton, or a bale of silks, with the same decision
that I do all the improbable and contradictory reports of
an epidemic yellow fever being imported  in a sailor's

  • M.  Savary,  in his Travels, says, two hundred persons live in Cairo -
within a compass that accommodate but thirty persons in I'ari3. 
          YELLOW FEVER  NOT CONTAGIOUS*     169

jacket, or in the timbers and sails of a ship that had been
washed by the salt water, and fanned by  the pure air of
the ocean, for several weeks, on  her passage from the
West-Indies to the United  States.
   In a former inquiry,* I have taken notice of the metas-
tasis of error from one  medical subject to another.   It is
to be lamented that a similar translation of error has taken
place from religion to medicine.   In the close of the 10th
century, Pope Gregory excommunicated  Robert, king of
France, for marrying his fourth cousin.  The king disre-
garded the edict of the pope, and continued to live with
his queen.  In  consequence of his doing  so, all his cour-
tiers and even his domestics deserted him,  two of the latter
only excepted.   But such was the dread of these two
faithful servants, lest they should be infected with the sin
of their royal master, that they threw all the remains of his
meals  to the dogs, and  even purified the vessels in which
they had been prepared.  Let the reader of this fact, who-
 ever he may be, pause and reflect, that if he  has at any
time deserted the sick chamber of a relation, a friend, or a
 neighbour inthe plague, or yellow fever, if he has destroy-
 ed the bedding or clothes of a person who has had either
 of those diseases, or if  he has approved of a law, which
 has imposed  upon a fellow citizen,  returning in health
 from a West-India voyage, an offensive fumigation, or a
 tedious quarantine at a  sickly lazaretto, in order to destroy
 their supposed contagiousness, let him be assured, what-
 ever his talents and acquirements may be, the folly of the
 domestics of  the kirjg of France cleaves to him in another
 form, and will inevitably consign his character with theirs,
 to the pity and ridicule of future  generations.
   It gives me  pleasure to  find the unpopular opinion of
 the non-contagiousness of the plague, which I have adopt-
 ed, is  not a  new  one.  It was  held by   the  Faculty of
 Medicine in  Paris,  in the beginning of  the eighteenth
 century, and was ably defended by Dr. Pringle and  Dr.
 Pye, about the year  1720, in two  very sensible pamphlets
 which are to be seen in the library of the Pennsylvania
 hospital, written in  opposition to Dr. Mead's learned and
 popular tract upon that subject, and which at once terrified
 and misled all the nations of Europe.  The same opinion
                       * Upon the Gout.
    VOL.IV.               Y 
170      YELLOW FEVER NOT CONTAGIOUS.
of the non-contagiousness of the plague has since been
maintained by Dr.  Stoll of Vienna, and Dr. Samoilowitz
of Russia, and several other eminent physicians.   Dr.
Heberden has lately called in question the truth of all the
stories that are uporurecord of the plague having been im-
ported into England in the last century, and the researches
of Sir Robert Wilson of the British army, and of Assellini,
and several other French physicians, have produced the
most  satisfactory proofs of  its not being  a contagious
disease in its native country.  A discovery more pregnant
with blessings to mankind has seldom been made.   Pyra-
mids of error, the works of successive ages and nations,
must fall before it, and rivers of tears must be dried up by
it. It is impossible fully to appreciate the immense benefits
which await this mighty achievement of our science upon
the affairs of the globe.  Large cities shall no longer be
the hot-beds of disease and death.   Marshy grounds,
teeming with pestilential exhalations, shall become the
healthy abodes of men.  A powerful source of repulsion
between nations shall be  removed, and  commerce shall
shake off the fetters which have been imposed upon it
by Expensive and vexatious  quarantines.  A  red or a
yellow eye shall no  longer be the signal to desert a friend
or a brother to perish alone in a garret or a barn,  nor to
expel the stranger from our houses, to seek an asylum in
a public hospital, to avoid dying in the street.   The num-
ber of diseases shall be lessened, and the most mortal of
them  shall be struck out of the list of human evils.  To
accelerate these events, it  is  incumbent upon the physi-
cians of the United States to second the discoveries of
their European brethren.   It becomes them constantly to
recollect, that we are the centinels of the health and lives
of our fellow-citizens, and that there is a grade of benevo-
lence in our profession much higher than that which arises
from the cure of diseases.   It  consists in exterminating
their causes. 
        A DEFENCE






             OF






BLOOD-LETTING,







             AS A





   REMEDY FOR CERTAIN DISEASES. 
te 
A  DEFENCE, &c.
    BLOOD-LETTING, as a remedy for fever,  and
certain other  diseases, having lately been the subject of
much discussion, and many objections having been made
to it which appear to be founded in error and fear, I  have
considered that a defence of it, by removing those objec-
tions, might render it more generally useful, in every part
of the United States.
  I shall begin this subject by remarking, that blood-let-
ting is indicated, in fevers of great morbid excitement.
  1. By the  sudden suppression or diminution of the
natural  discharges by  the pores, bowels, and kidneys,
whereby a plethora is induced in the system.
  2. By the habits of the persons who  are most  subject
to such fevers.
  3. By the  phenomena of fever.  I have attempted to
prove that the higher grades of fever depend upon  morbid
and excessive action in the blood-vessels.  It is connected
of course, with preternatural sensibility in their  muscular
fibres.   The blood is the most powerful irritant which
acts upon them.  By abstracting a part of it, we lessen
the principal cause of the fever.  The effect of blood let-
ting is as immediate  and natural  in removing fever, as
the abstraction of a particle of sand is, to cure an  inflam-
mation of the eye, when it arises from that cause.
  4. By the symptoms of the first stage of violent fevers,
such as a sleepiness and an oppressed pulse, or by deli-
rium, with a  throbbing pulse,  and great pains in every
part of the body.
   5.  By  the rupture of the blood-vessels, which takes
place from the quantity or impetus of the blood in fevers
Of great morbid action.   Let no one call bleeding a cruel
or unnatural remedy.   It is one of the specifics of nature;
but in the use of it she seldom affords much relief.   She 
174
DEFENCE OF BLOOD-LETTING.
 frequently pours the stimulating and oppressing mass of
 blood into the lungs and brain; and when she finds  an
 outlet for it through the nose, it is discharged either in
 such a deficient or excessive quantity, as to be useless or
 hurtful.  By artificial  blood-letting, we can  chuse the
 time and place of drawing blood, and we may regulate its
 quantity by the degrees of action in the blood-vessels.
 The disposition of nature to cure violent morbid action
 by depletion, is further manifested by  her substituting,
 in the room of blood-letting, large, but less safe and less
 beneficial, evacuations  fron the  stomach and bowels.
   6. By the structure and use of the spleen.  I  have call,
 ed it in my lectures upon physiology, a bason furnished
 by nature to hold redundant blood, or to afford it a tem-
 porary asylum, when the blood-vessels are unduly excited.
 Now the spleen is sometimes too small, and often so over-
 charged with blood, or  so obstructed, that it cannot per-
 form this office, in which case blood-letting is  indicated.
 The great enlargement and engorgement of the spleen in
 fatal cases of bilious fevers where sufficient bleeding has
 not been used, prove the truth of this remark.   The re-
 lief which bleeding gives in  chronic and winter intermit*
 tents, is probably occasioned by the spleen being so much
 obstructed,  as not to receive the  blood in a paroxysm of
 fever.   The lancet here performs its vicarious office.
   7.  By the relief which is  obtained in  fevers of violent
 action by remedies of less efficacy (to be  mentioned here-
 after), which act  indirectly in reducing  the force of the
 sanguiferous system.
   I. By the immense  advantages  which have  attended
 the use of blood-letting in violent fevers, when used at a
 proper time, and in a quantity  suited to the force of the
 disease.  I shall briefly enumerate these advantages.
   1.  It frequently strangles a fever, when used in its form-
 ing state, and thereby saves much pain, time,  and ex-
 pense to a patient.                         N
  2.  It imparts strength to  the body, by removing the
 depression which  is induced by the remote cause of the
fever.   It removes a disposition to faint,  which arises
from  this state of the system.
  3.  It reduces the uncommon frequency of the pulse. 
DEFENCE OF BLOOD-LETTING.
175
The loss  of ten  ounces of blood reduced Miss Sally
Eyre's pulse from 175 strokes to 140, in a few minutes,
in the  fever  of the year 1794.   Dr. Gordon mentions
many similar instances of its reducing the frequency of
the pulse, in the puerperile fever.
   4. It renders the pulse more frequent  when it is pre-
ternaturally slow.
   5. It checks the nausea and vomiting, which attend
the malignant state of fever.   Of this I saw many instan-
ces in the year  1794.   Dr. Poissonnier Desperrieres con-
firms this remark, in his Account  of the Fevers of St.
Domingo; and adds further, that it prevents, when suffi-
ciently copious, the troublesome vomiting which often
occurs on the fifth day of the  yellow fever*  It has the
same effect in preventing the diarrhoea in the measles.
   6. It  renders  the bowels, when  costive, more easily
moved by purging physic.
   7. It renders the action of  mercury more speedy and
more certain, in exciting a salivation.
    8. It disposes the body  to  sweat spontaneously, or
renders diluting and diaphoretic medicines more effectu-
al for that purpose.
    9. It suddenly removes  a  dryness, and gradually a
 blackness,  from  the tongue.   Of  the former  effect of
 bleeding, I saw two instances, and of the latter, one, dur-
 ing the autumn of 1794.
    10.  It  removes or lessens pain  in every part of the
 body, and more especially the head
    11.  It removes or  lessens the burning heat of the skin,
 and the burning heat in the stomach,  so common and so
 distressing in yellow fever.
    12. It removes a constant chiliness, which sometimes
 continues for several days, and which will neither yield
 to cordial drinks, nor warm bed clothes.
    13. It checks such sweats as are profuse without af-
  fording relief, and renders such as are partial and moder-
  ate, universal and salutary.
    14. It sometimes checks  a diarrhoea and  tenesmus,
  after astringent medicines have been given to no purpose.
  This has often been observed in the measles.
• Traite des Fievres de l'lsle de St. Dominqne, vol ii p- 7$- 
176         DEFENCE  OF BLOOD-LETTING^

  15. It suddenly cures the intolerance of light which ac-
companies many of the inflammatory states of fever.
  16. It removes coma.   Mr. Henry Clymer was sud-
denly relieved of this alarming symptom, in the fever of
1794, by the loss of twelve ounces of blood.
  17. It induces sleep.   This effect of bleeding is  so
uniform, that it obtained, in the year 1791,  the name of
an anodyne  in several families.  Sleep sometimes stole
upon the patient while the blood was flowing.
  18. It prevents  effusions of serum and blood.  Hae-
morrhages seldom  occur, where bleeding has been suffi-
ciently copious.
  19. It belongs to this remedy to prevent the chronic
diseases of cough,  consumption, jaundice, abscess in the
liver, and all the different states of dropsy which so often
follow autumnal fevers.
  My amiable friend, Mrs. Lennox, furnished an excep-
tion  to this remark, in the year 1794. After having been
cured of the yellow fever by seven bleedings, she  was af-
fected, in consequence  of taking a ride, with a slight re-
turn of fever, accompanied by  an acute pain in the head,
and  some of the symptoms of a dropsy of the brain.  As
her pulse was tense and quick, I advised repeated bleed-
ings to remove it.  This prescription, for reasons which
it is unnecessary to relate, was not followed at the time,
or in the manner, in  which it  was recommended.  The
pain, in the mean time, became more alarming.  In this
situation, two physicians  were  proposed by her friends to
consult with me.  I objected to them both, because I
knew their principles and modes of practice to be contra-
ry to mine, and that they were proposed only with a view
of wresting the lancet from my hand.   From this desire
of avoiding a controversy with my brethren, where con*
viction was impossible  on either side, as well as to obviate
all cause of complaint  by my patient's  friends, I offered
to take my leave of her,  and to resign her  wholly to the
care of  the two gentlemen who were proposed to attend
her with me.  To this she objected in a decided manner.
But that I might not be suspected of an undue reliance
upon my own judgment, I proposed to call upon Dr. Grif-
fitts or Dr. Physick to assist me in my attendance upon 
DEFENCE OF BLOOD-LETTING.        177
her.  Both these physicians had renounced the prejudices
of the schools in which they had been educated, and had
conformed their principles and  practice to the  present
improving state of medical science.  My patient preferred
Dr. Griffitts, who, in his first visit to her, as  soon  as he
felt her pulse, proposed more bleeding.  The operation
was performed by the doctor himself, and repeated daily
for five days afterwards.   From an apprehension that the
disease was so fixed as to require some aid to blood-letting,
we gave her calomel in such large doses as to  excite a
salivation.   By the use of these remedies she recovered
slowly, but so perfectly as to enjoy her usual health.
  20. Bleeding prevents  the termination of malignant,
in the gangrenous state of fever.  This effect of blood-
letting will enable  us to  understand some things in the
writings of Dr.  Morton and Dr. Sydenham, which at first
sight appear to be unintelligible.   Dr. Morton describes
what he calls a putrid fever, which was epidemic and fa-
tal, in the year  1678.  Dr. Sydenham, who practised in
London at the same time, takes no  notice of this  fever.
The reason of his silence  is obvious.  By copious bleed-
ing, he prevented the fever of that year from running on
to the gangrenous state,  while Dr. Morton, by neglecting
to bleed, created the supposed putrid fevers which he has
described.
   It has been common to charge  the friends of blood-
letting with temerity in their practice.   From this view
which has been given of it,  it appears, that it would be
more proper to ascribe timidity  to them, for they bleed to
prevent the offensive and distressing consequences of ne-
glecting it,  which have been mentioned.
  21. It cures, without permitting a fever to put on those
alarming symptoms, which excite constant apprehensions
of danger and death, in  the minds of patients and their
friends.   It is because these alarming symptoms are pre-
vented, by bleeding, that patients are sometimes unwilling
to believe they had been cured by it, of a malignant fever.
Thus, the Syrian leper of old, viewed the water of Jordan
as too simple and too common  to cure a formidable dis-
ease, without recollecting that the remedies for the greatest
   VOL. iv.                z 
178        DEFENCE OF BLOOD-LETTING,
evils of life are all simple, and within the power of the
greatest part of mankind.
  22. It prepares the way for the successful use of the
bark and other tonjc remedies, by destroying, or so far
weakening, a morbid action in the blood-vessels, that  a
medicine of a moderate stimulus afterwards exceeds it in
force, and thereby restores equable and healthy action to
the system.
  23. Bleeding prevents relapses. It, moreover, prevents
that predisposition to the intermitting and pleuritic states
Df fever, which so frequently attack persons in the spring,
who have had the bilious remitting fever in the preceding
autumn.
  But great and numerous as the advantages of blood-
letting are in fevers, there have been many objections to
it.  I shall briefly enumerate,  and endeavour to refute the
errors upon this subject.
  Blood-letting has been forbidden by physicians, by the
following circumstances, ami states of the system.
   1. By warm weather.   Gakn bled  in  a plague, and
Argeteus in a bilious fever, in a warm climate.   Dr. Sy-
denham and Dr. Hillary inform us, that the most inflam.
matory  fevers occur in, and succeed hot weather. Dr.
Cleghorn prescribed it copiously in the warm months, in
Minorca.  Dr. Mosely cured the yellow  fever by this
remedy, in Jamaica.  Dr. Broadbelt, and  Dr. Weston in
the same island,have lately adopted his successful practice.
Dr. Desportes speaks in the highest terms of it in all the
inflammatory diseases of St.  Domingo. IJe complains of
the neglect of it in the rheumatism,  in  consequence of
which,  he says, the disease  produces abscesses in the
lungs.  Dr.  Pugnet says the native  physicians of upper
Egypt bleed in all violent diseases.  They are governed
in their practice by the state  of the pulse in the temples,
and when it does not afford the indication sought for, they
regulate the use of the lancet by the greater or less  red
colour of the body.   I have  never,  in any year of my
practice, been restrained by the heat of summer in the use
of the lancet, where the pulse has indicated it to be neces-
sary, and have always found  the same advantages from it,
as  when I have  prescribed  it in the winter or spring
months. 
DEFENCE OF BLOOD-LETTING.
179
  In thus deciding in favour of bleeding in warm weather,
I do not  mean to defend its use to the same extent, as to
disease^,  or to quantity, in the native and long settled in-
habitants of hot climates, as in persons who have recently
migrated to them, or who live in climates alternately hot
and cold.
  2. Being born, and having lived in a warm climate.
This is so far from being an objection to blood-letting in
an inflammatory disease, that it renders it more necessary.
I think I have lost several West-India patients from the
influence of this error.
  3. Great apparent weakness.  This, in acute and vio-
lent fevers, is always from a depressed state of the system.
It resembles, in so many particulars, that weakness which
is the effect of the abstraction of stimulus,  that it is no
wonder they have been confounded by physicians. This
sameness of symptoms from opposite states of the system
is taken notice of by Hippocrates.  He describes convul-
sions, and particularly a hiccup, as occurring equally from
repletion and inanition, which answer to the terms of de-
pression, and debility from action  and abstraction.  The
natural remedy for the former is depletion,  and no mode
of depleting is so effectual or safe  as blood-letting.   But
the great objection to this remedy is, when a fever of great
morbid excitement affects persons of delicate constitutions,
and such as have long been  subject to debility of the
chronic kind.  In this  state of the system,  there is the
same morbid and preternatural action in the blood  vessels,
that there  is  in  persons  of robust habits, and the same
 remedy is necessary to subdue it  in both  cases.  It  is
 sometimes indicated in a larger quantity in  weakly  than
 in robust people, by the plethora  which is  more easily
 induced in their relaxed and yielding blood-vessels, and
 by the greater facility with which ruptures  and effusions
 take place in their viscera. Thus  it is more necessary to
 throw overboard a large part of the cargo of an  old and
 leaky  vessel  in a storm, than of a new and strong one. I
 know that vomits, purges, sweats, and other evacuating
 remedies, are preferred to bleeding  in  weakly constitu-
 tions, but I hope to show hereafter, that bleeding is not
 only more effectual, but more safe in such  habits,  than
 any other depleting remedy. 
180        DEFENCE OF BLOOD-LETTING-
  4. Infancy and childhood. Bleeding is so far from be-
ing forbidden by these stage's of life, that it is called for
jn a greater degree under equal circumstances, than  in
the diseases of adults, by the peculiar excitability of the
blood-vessels in children, by the difficulty of reducing
their systems by means of sweats, and in diseases  of the
lungs and trachea, by their  inability under two) ears old,
to remove the irritation excited by  phlegm and mucus in
those organs, by  expectoration.   Dr.  Sydenham  bled
children in the hooping cough, and in dentition.  I bled
my eldest daughter when she was  but six weeks old, for
convulsions brought on by an excessive dose of laudanum
given to her by her nurse;  and I bled one of my  sons
twice* before he was two months old, for an acute fever
which fell upon his lungs and bowels. In both cases, life
appeared to be saved by this remedy.  I could mention
many more instances in which it has snatched from the
grave, children  under three and four months old, by be-
ing used from three to five  times in the  ordinary  course
of their acute diseases.
  5.  Old age.   The increase of appetite in old people,
their inability to use  sufficient  exercise, whereby  their
blood-vessels become rela xed, plethoric, and excitable, and
above all, the translation of  the strength of the muscles to
arteries,  and of plethora to the veins, all indicate bleeding
to be more necessary (in equal circumstances) in old, than
in middle aged  people.  My practice in the diseases of old
people has long been regulated by the above facts. I bled
Mrs. Fullerton twice in a pleurisy in January, 1804, in the
84th year of her age, and thereby cured her disease. I drew
six  and thirty ounces of blood, in the year 1806, at three
bleedings,  from Mr.  Israel  Jacobs in the 91st year of his
age, in a bilious fever, in the course of a few days.   He
was cured by this remedy,  and at  this time, July 29th,
1809, enjoys good health.   I am not  the author  of this
bold practice.   Botallus left a  testimony in favour  of it
nearly 200 years ago,* and it has since  been confirmed
by the experience of Hoffman, and many other physicians.
An ignorance of, or inattention to this change in the state
  • Mafyis esse adjtivaiidos senes, missione sanguinis dum morbus postnlat,
aut corpus eorum habitus mains est, quam ubi  bxc (quod absonum videbi
tur)  juvenibus eontingunt.
                      De Cur. per Sang, missionem, cap. 11. $ 11 
DEFENCE OF BLOOD-LETTINC.
181
of the blood-vessels, in persons in the decline of life, and
the neglect of the only remedy indicated by it, is proba-
bly the reason why diseases often prove fatal to them,
which in early or middle life cured themselves, or yield-
ed to a single dose of physic, or a few ounces of bark.
  6. The time of menstruation.  The uterus, during this
period, is in an inflamed  state, and the whole  system is
plethoric-and excitable, and of course disposed to a violent
degree of fever, from all the causes which excite it. Bleed-
ing, therefore, is more indicated, in fever of great morbid
action, at this time, than  at any other.  Formerly the na-
tural discharge from the  uterus was trusted to, to remove
a fever contracted during the time of menstruation;  but
what relief can the  discharge of four or five ounces of
blood  from the uterus  afford, in a fever which requires
the loss of 50,  or perhaps 100 ounces to cure it?
   7. Pregnancy. The inflammation and distention indu-
ced upon the uterus by pregnancy, and the inflammatory
diathesis thereby imparted to the whole system, rendev
bleeding, in the acute states of fever, more necessary than
at other  times. I have elsewhere mentioned the advanta-
ges of bleeding pregnant women, in the yellow fever.   I
did not learn the advantages of the practice in that disease.
I bled  Mrs. Philler 11 times in  seven days, in a pleurisy
during her pregnancy, in  the  month of  March,  1783.
Mrs. Fiss was bled  13 times in  the spring of  1783;  and
Mrs. Kirby 16 times in the same condition, by my orders,
in the winter of 1786, in a  similar  disease.  All these
women recovered, and the children they carried during
their illness, are at this time alive, and in good health.
   8. Fainting after bleeding.  This symptom is acciden-
tal in many people.  No inference can be drawn from  it
against blood-letting.  It often occurs after the first  and
second bleedings in  a fever, but in no subsequent bleed-
ing, though it be repeated a dozen times. Of this I  saw
several instances, in the yellow fever of 1794. The pulse,
during the fainting, is often tense and full.
   9. Coldness of the extremities, and of the whole body.
This cold state of fever when it occurs early, yields more
readily to bleeding, than to the most cordial medicines.
   10.  Sweats are supposed to  forbid  blood-letting.  I
have seen two instances of death, from having a paroxysm 
182       DEFENCE  OF BLOOD-LETTING.

of malignant fever to terminate itself by sweating.   Dr.
Sydenham has taught a contrary practice in the following
case.   " While this constitution^says the doctor) prevail-
ed, I was called to Dr. Morice,  who then  practised in
London. He had this fever, attended with profuse sweats,
and numerous petechiae.  By the consent of some other
physicians, our joint friends, he was blooded, and rose
from his bed, his body being first wiped dry.  He found
immediate relief  from  the use of a cooling diet and medi-
cines, the dangerous symptoms soon going  off, and  by
continuing this method he recovered in  a few  days."*
In the same fever, the doctor adds further, " For though
one might expect great advantages in pursuing  an  indi-
cation taken from what generally proves serviceable (viz.
sweating,) yet I have found, by constant experience, that
the patient not only  finds no relief,  but,  contrariwise, is
more  heated thereby; so that  frequently a delirium, pe-
techiae,  and other very  dangerous symptoms immediately
succeed such sweats."\
  Morgagni  describes  a malignant  fever which prevailed
in Italy, in wrhich the  patients died in  profuse sweats,
while their physicians were looking for a crisis from them.
Bleeding would probably have checked these sweats, and
cured the fever.
  11. Dissolved blood, and an absence of an inflamma-
tory crust on its crassamentum.   I shall hereafter place
dissolved blood at the highest point of a scale, which is
intended to mark the different degrees of morbid action
in the system. I have mentioned, in the Outlines of the
Phenomena of Fever, that it is the  effect of a tendency
to a palsy, induced  by the violent  force of  impression
upon  the blood-vessels, rending  and tearing die blood to
pieces.  This appearance of the blood  in certain states
of fever, instead of forbidding bleeding, is  the most ve-
hement  call of the system for it.  Nor is  the  absence of
a crust on the crassamentum  of the blood,  a proof of
the absence of great morbid diathesis, or a signal to lay
aside  the lancet.  On the contrary, I shall show hereafter,
that there are several appearances of the blood which indi-
* Wallis's edition, vol. i. p. 210,
t Vol. i. p. 208. 
DEFENCE OF BLOOD-LETTING.
183
cate more morbid action in the blood-vessels than a sizy
qt inflammatory crust.
  12. An undue proportion of  serum to crassamentum
in the blood.  The predominance of water in the blood
has often checked sufficient blood-letting.  But it should
be constantly disregarded, while it is attended with those
states of pulse (to be mentioned hereafter) which require
bleeding.
   13. The presence of petechiae on the skin.  These, I
have elsewhere  said, are the  effects of  the  gangrenous
state of fever.   Dr. Sydenham and Dr.  de  Haen have
taught the safety and advantage of bleeding, when these
spots are accompanied by an  active pulse.   A  boy of
Mr. John Carrol owes his recovery from the small-pox
to the loss of fifty ounces of blood, by five bleedings,
at a time when  nearly every pock on his arms and legs
had a purple appearance  Louis  XIV. was bled five
times in the small-pox, when he was but thirteen years
of age,  and thereby probably saved from  the grave, to
the great honour and emolument  of the  single physician
who urged it against the advice  of all the other  physi-
cians of the court.  Dr. Cleghorn mentions a single case
of the success of  bleeding in the  petechial  small-pox.
His want of equal success afterwards, in  similar cases,
was probably occasioned by his bleeding too sparingly,
that is,  but three or four times.
   Abscesses and sore breasts,  which accompany or suc-
ceed fever, are no  o jections  to blood-letting, provided
the pulse indicate the continuance of inflammatory dia-
thesis.  They depend frequently upon the same state of
the system as livid effusions on the  skin.
   14. The long duration of fever.  Inflammatory diathe-
sis is often protracted for many weeks,  in the chronic
state  of fever.   It, moreover, frequently revives after
having disappeared, from an accidental irritant affecting
some put of the body, particularly the lungs and brain.
I bled a young man of James Cameron, in the autumn of
1794, four times between the 20th  and  30th days of a
chronic fever, in consequence of a pain in the side,  ac-
companied  by   a  tense  pulse,  which suddenly came on
after the 20th day of his disease.   His blood was sizy. 
,184       DEFENCE OF BLOOD-LETTING.

His pain and tense pulse were subdued by the  bleeding
and he recovered.  I bled the late Dr. Prowl twelve timesr
in a fever which continued thirty days, in the autumn of
the year 1800.   I wish  these cases to be  attended to by
young  practitioners.  The pulmonary consumption is
often  the effect of a chronic fever, terminating with fresh
inflammatory symptoms, by effusions in  the lungs.   It
may easily be prevented by forgetting the number of the
days of our patient's fever, and treating  the pulmonary
affection as if it were a  recent complaint.
   15.  Tremors and slight convulsions in  the limbs.
Bark, wine, laudanum and musk are generally prescribed
to remove these  symptoms; but, to be  effectual,  they
should, in most cases, be preceded by the loss  of a  few
ounces of blood.
   16. Bleeding is forbidden after the fifth or seventh day
in a pleurisy.  This prohibition was introduced into me-
dicine at a time  when a fear was entertained of  arresting
the progress of nature in preparing and expelling morbific
matter  from  the system.  From repeated experience I
can assert, that bleeding is safe in every stage of pleurisy
in which  there is pain, and a tense and oppressed pulse;
and that it has, when used for the first time after the  fifth
and seventh days, saved many  lives.  Bleeding has like-
wise been limited to a certain number of ounces in seve-
ral states of fever.  Were the  force of the remote cause
of a fever, its degrees of violence, and the habits of the
subject of it, always the same, this rule would  be a  pro-
per one; but, this not being the case, we must be  gov-
erned wholly by the condition  of the system, manifested
chiefly  by the state of the pulse.  To admit of copious
bleeding in one state of fever,  and not in another, under
equal circumstances of morbid  excitement, is to prescribe
for its name, and to  forget the changes   which climate,
season, and  previous habits  create in  all its different
states.
   17. The loss of a sufficient  quantity of blood is often
preventedby patients being apparently worse, after the first
or second bleeding.   This change for the worse, shows
itself in some one or more of  the following symptoms,
viz. increase-of heat, chills, delirium, haemorrhages, con- 
           DEFENCE OF BLOOD-LETTING.        135

vulsions, nausea, vomiting, faintness, coma, great weak-
ness, pain, a tense,  alter a soft puibe,  and a reduction of
k ni force an J frequency. The\  are .11 occasioned by the
system rising  suddenly from a stae of extreme depres-
sion,  in consequence of the abstraction of the pressure
of the blood to a state of vigour and activity, so great, in
so ne instances, as to reproduce a depression below what
existed in the system before a vein was opened;  or  it is
occasioned by a translation of morbid action from one part
of the body to  another.
  The chills which follow bleeding are the effects  of a
change in the fever,  from an  uncommon to a common
state of malignity.   They occur chiefly in those violent
cases of fever which come on without a chilly  fit.
  The haemorrhages produced by bleeding are chiefly
from the  nose,  haemorrhoidal vessels,  or uterus, and of
course  are, for the most part,  safe.
  Uncommon  weakness, succeeding blood-letting, is the
effect of sudden depression induced upon  the whole sys-
tem,-by  the cause  before mentioned, or of a sudden
translation of the  excitement of the  muscles  into the
blood-vessels,  or some other part  of the body.  These
symptoms, together with all others which have  been men-
tioned, are so far from forbidding, that they almost forci-
bly indicate a repetition of blood-letting.
  I shall  briefly illustrate, by the recital  of three cases,
the good effects of bleeding,  in removing pain,  and the
preternatural slowness and weakness of the pulse, when
produced by the use of that remedy.
  In the  month of June of 1795, I visited Dr.  Say in a
malignant fever, attended with  pleuritic symptoms, in
consultation  with  Dr.  Physick.    An acute pain in his
head followed  six successive bleedings.  After a seventh
bleeding, he had no pain.   His fever soon afterwards left
hi u.   In thus  persevering in the  use of a remedy, which,
for several days, appeared to do harm, we were guided
wholly by the state of his pulse, which uniformly indicat-
ed, by its force, the necessity of more bleeding.
   In the autumn of 1794, I was  sent  for to visit Samuel
Bradford, a voting man  of about 20 years of age, son of
 Mr. Thomas Bradford, who  was  ill with the  reigning
   vol.  iv.                a a 
 186       DEFENCE OF  BLOOD-LETTING.

 malignant epidemic.  His pulse was at 80.  I drew about
 12 ounces  of blood from him.   Immediately  after his
 arm was tied up, his pulse fell to 60 strokes in a minute.
 I  bled him a second time, but  more plentifully than be-
 fore,  and thereby in a few minutes,  brought his pulse
 back again to 80 strokes in a minute.   A third bleeding
 the next day aided by the usual  purging physic,  cured
 him in a few days after.
   In the month of March, 1795, Dr.  Physick requested
 me to visit, with him, Mrs. Fries,  the wife of Mr. John
 Fries, in a malignant fever.   He had bled her four times.
 After her fourth bleeding, her pulse suddenly fell,  so as
 scarcely to be  perceptible.   I found  her hands and feet
 cold, and her countenance ghastly,  as if she were in the
 last moments of life.  In this alarming  situation,  I sug-
 gested nothing to Dr. Physick but to follow his judgment,
 for I knew that he was master of that law of the  animal
 economy which resolved all her  symptoms into an oppres-
 sed state of the system.  The docter decided in a moment
 in favour of more bleeding.   During the flowing  of the
 blood the pulse rose. At the end of three, ten, and seventeen
 hours it fellj and rose again by three  successive bleedings,
 in all of which she lost about thirty ounces of sizy blood.
 So great was the vigour acquired by the pulse, a few days
 after the paroxysms of depression,  which have been de-
 scibed,  were relieved, that it required seven more bleed-
 ings to  subdue it.  I wish the history of these two cases
 to be carefully  attended to by  the reader.   I have been
thus minute in the detail  of them, chiefly because I have
 heard of practitioners who have lost patients by attempt-
ing to raise a pulse that had been depressed by bleeding,
 in a malignant fever, by means of cordial medicines, in-
 stead of the repeated use  of the lancet.   The practice is
 strictly rational; for, in proportion as the  blood-vessels
 are weakened by pressure, the quantity of  blood to be
 moved should be proportioned  to the  diminution of their
 strength.
   This depressed state of  the pulse, whether induced by a
 paroxysm of fever,  or by  blood-letting, is sometimes aU
 tended  with a strong pulsation of the arteries in the bow-
 els and  head. 
             DEFENCE OF BLOOD-LETTING.   '     18?

   I have mentioned,  among the apparent bad effects  of
 bleeding,  that it sometimes changes a soft into a tense
 puise.   Of this  I saw a remarkable  instance in Captain
 John Barry, in the autumn of 1795.  After the loss of 130
 ounces of blood in a malignant yellow fever, his pulse be*
 came so soft as  to  indicate no more bleeding.  In this
 situation he remained for three days, but  without  mend*
 ing as rapidly as 1 expected from the state  of his  pulsei
 On the fourth day he had a haemorrhage from his bow-
 els, from which he lost above a pint of blood.   His pulse
 now suddenly became tense, and continued  so for two or
 three days.   I ascribed this change in his pulse to the
 vessels of the bowels, which had been oppressed by con*
 gestion, being so much relieved by the haemorrhages, as
 to resume  an inflammatory action.  I have  observed a
 similar change to take place in  the pulse, after a third
 bleeding, in a case of haemorrhoidal  fever, which came
 under my notice in  the month of January,  1803.   It  is
-thus we see the blood-vessels, in a common phlegmon,
 travel back again, from a tendency to mortification, to the
'*red colour and pain of common inflammation.
   From a review of the commotions excited in the sys-
 tem by bleeding, a reason may be given why the  physi-
 cians, who do not bleed in the depressed state of the pulse,
 ,have so few patients in what they call malignant fevers,
 compared with those who use a contrary practice.   Thd
 disease, in such  cases, being locked up, is not permitted
 to unfold its true  character; and hence  patients are said
 .to die of apoplexy, lethargy, cholera, dysentery, or nervous
 fever, who,  under a different treatment, would have ex-
 hibited all the marks of an ordinary malignant fever.
   In obviating the  objections to blood-letting from its
 apparent evils, I have said nothing of the apparent bad
 effects of other remedies.   A  nausea  is  often rendered
 worse by an emetic, and pains in the bowels are increased
 by a purge.   But these remedies notwithstanding main-
 tain*, and justly too,  a high character among  physicians.
   19. Bleeding has  been accused of bringing  on a ner-
 vous, or the chronic state of fever.   The use of this re-
 medy, in a degree so moderate as to obviate the putrid
 or gangrenous state of fever only,  may induce the chrorri 
188
DEFENCE OF BLOOD-LETTING.
state of fever;  for  it is the effect, in this case, of the re-
mains of inflammatory diathesis in the blood-vessels; but
when blood is  drawn proportioned to the morbid ac
tion in the system, it is impossible for a  chronic fever
to be produced by it.  Even the excessive use of bioodi
letting,  however injurious it  may  be in other.respects,
cannot produce a chronic fever, for it destoys morbid
action altogether in the blood-vessels.
   20. Bleeding has bem charged with being a weakening
remedy.   I grant  that it is so, and in this, its merit chiefly
consists.  The excessive morbid action of the biood-vts-
sels must be subdued in part in a fever, before stimulating
remedies can be given with safety or advantage.   Mow
this is usually attempted by depleting  medicines,  to be
mentioned hereafter,  or it is left to time and nature, all of
which are frequently either deficient, or excessive in their
operations; whereas bleeding,  by suddenly reducing the
morbid action of the  blood vessels  to a wished-for  point
of debility, saves  a great and unnecessary waste of exci*
lability, and thus  prepares the  body for the exhibition of
such cordial remedies as are proper to remove the debility
which predisposed to the fever.
   21. It  has been said that bleeding renders  the.habitual
use of it necessary to health and life.   This objection to
blood-letting is  founded upon  an ignorance of the differ.
ence between the healthy, and morbid action of the blood-
vessels.   Where blood is drawn in health, such a  relax-
ation is induced in the  blood-vessels, as to favour the
formation of plethora, which may require habitual bleed-
ing to remove it;  but where blood  is drawn only in the
inflammatory state of faver, the blood-vessels  are reduced
from a morbid degree of strength to that which is natural,
in which state  no predisposition to plethora is created,
and no foundation laid for periodical blood-letting.  But
there are cases which require even this evil, to prevent a
greater.   Thus we cure a strangulated hernia, when no
fever attends, by the most profuse bleeding.  The ple-
thora and predisposition to disease which follow  it  are
trifling,  compared with preventing certain and sudden
death.
   22. Bleeding has been accused of bringing on an  in- 
DEFENCE OF BLOOD-LETTING-
189
termitting fever.  This is so iar  irom being an objection
to it, that it should be considered as a new argument in
its favour,  for when it produces that state of fever, it con-
verts a latent, and perhaps a dangerous disease, into one
that is obvious  to the senses, and under the dominion of
medicine.   Nor is it  an objection  to blood-letting, that,
when used in an inflammatory intermittent, it sometimes
changes it into  a continual fever.   A instance of the good
effects of this change  occurred in  the Pennsylvania hos-
pital, in an obstinate tertian, in the year 1804.  The con-
tinual fever, which followed the loss of blood, was cured
in a few days, and by  the most simple remedies.
  23. It has been  said  that  bieeding, more especially
where it is copious, predisposes to effusions of serum in
the lungs, chest, bowels, limbs, and brain.   In replying
to this objection to bleeding, m my public lectures, 1 have
addressed  my  pupils in the following  language:   "Ask
the poor patients who come panting to the door of our
hospital, with  swelled legs and  hard bellies, every fall,
whether they have  been too copiously bled, and they will
all  tell you, that no lancet has come near their arms. Ask
the parents who still  mourn the loss of children who have
died, in our city, of the internal dropsy of the brain, whe-
ther they were  destroyed by excessive blood-letting.   If
the remembrance of the  acute sufferings  which accompa-
nied  their sickness and  death  will permit these  parents
to  speak,  they  will tell you, that every medicine, ex-
cept  bleeding,   had  been  tried to no  purpose in their
children's diseases.  Go  to  those  families in  which  I
have practised for many years,  and inquire,  whether
there is a living or a dead instance of dropsy having fol-
lowed, in any  one of them, the use of  my lancet.  Let
the undertakers and  grave-diggers bear witness against
me, if I have ever, in the course of my practice, convey-
 ed the body of a single dropsical paiient into their hands,
 by excessive blood-letting. No.  Dropsies, like abscess-
 es and gangrenous  eruptions on the skin, arise, in most
 cases, from want of  sufficient  bleeding  in inflammatory
 diseases.  Debility,  whether induced  by action  or  ab-
 straction,  seldom disposes to effusion.   iVho ever heard 
190         DEFENCE OF BLOOD-LETTING.

of dropsy succeeding famine. And how rarely do we see
it accompany the extreme debility of old age "
  " If ever bleeding kills," says Bottafius, either directly
or indirectly, through the instrumentality of other diseases,
" it is not from its excess, but because it is not drawn in
a sufficient quantity, or at a proper time,*"  And, again,
says this excellent writer,  ' One hundred thousand men
perish from  the want of blood-letting, or from its being
used out of time, to one who perishes from too much
bleeding, prescribed by a physician.f"
  It is remarkable, that the dread of producing a dropsy
by bleeding, is confined chiefly  to its use in malignant
fevers; for the men who urge this objection to it, do not
hesitate to draw four or five quarts of blood  in the cure
of the pleurisy.   The habitual association of the lancet
with this disease,  has often caused me to rejoice w hen I
heard a  patient complain of a pain in  the side, in a'malig-
nant fever.   It insured to me his consent  to the frequent
use of the lancet, and it protected me, when it was used
unsuccessfully, from the clamours of the public, for few
people censure copious bleeding in a pleurisy.
  24s. Against blood-letting it has been urged, that the
Indians of our  country cure their  inflammatory  fevers
without it.   To relieve myself from the distressing ob-
loquy to which my use of this remedy formerly exposed
me, I have  carefully sought for, and examined their re-
medies for those  fevers, with a sincere desire to adopt
them; but  my inquiries have convinced  me,  that they
are not only disproportionate to the habits  and diseases of
civilized life, but  that they  are  far less successful than
blood-letting, in curing the inflammatory fevers which oc-
cur among the Indians themselves.
  25. F.vacuating remedies of another kind have been
said to be more safe than bleeding, and equally effectual,
in reducing  the inflammatory state of fever.  I shall enu-
merate each of these evacuating remedies, and then draw
a comparative view of their effects  with blood-letting.
They are,
  I. Vomits.
• Cap. via. § 4.          t CaP" xxxvi* $ ^ 
DEFENCE OF BLOOD-LETTING.
191
   II.  Purges.
   III.  Sweats.
   IV.  Salivation.   And,
   V.  Blisters.
   I. Vomits  have been often effectual  in  curing fevers
 of a mild character.   They discharge offensive and irri-
 tating matters from the stomach; they lessen the fulness
 of the  blood-vessels, by determining the  serum of the
 blood  through the pores; and they equalize the excite-
 ment of the system, by inviting its excessive degrees from
 the blood-vessels to the stomach and muscles.  But they
 are,
   1. Uncertain in their operation, from the torpor induced
 by the  fever upon the stomach.
   2.  They are unsafe in many conditions of the system,
 as in pregnancy,  and a disposition to apoplexy and rup-
 tures.   Life has sometimes been destroyed by their in-
 ducing cramp, haemorrhage, and inflammation in the
 stomach.
   3. They are not subject to the control of a physician,
 often operating more, or less than was intended by him,
 or indicated by the disease.
   4. They are often ineffectual in mild, and always so in
 fevers  of great morbid action.
   II.  Purges are useful  in discharging acrid faeces  and
 bile from the bowels in fevers.   They act,  moreover, by-
 creating an artificial weak part, and  thus invite morbid
 excitement from the blood-vessels to the bowels.  They
 likewise lessen the quantity of blood, by preventing fresh
 accessions of chyle being added  to  it;  but like vomits
 they are,
   1. Uncertain in their opperation;  and from the same
 cause.   Many ounces of salts and castor oil, and  whole
 drachms of calomel and jalap, have often been given, with-
 out effect, to remove the costiveness which is connected
 with the malignant state  of fever.
  2. They are not subject to the direction of a physician,
with respect to the time of their opperation, or the quanti-
ty or  quality  of matter  they are intended  to discharge
from the bowels. 
192        DEFENCE OF BLOOD-LETTING.

  3. They are unsafe in the advanced stage  of fevers.
Dr. Physick informed me,  that three patients died in the
water-closet, under the operation ol purges, in St. George's
hospital, during his attendance upon  it.    I  have  seen
death,  in several instances, succeed a plentiful spontane-
ous stool in debilitated habits.
  III.  Sweating was introduced into practice at a time
when morbific matter was  supposed to be the  proximate
cause of fever.   It  acts, not by expelling any thing ex-
clusively morbid from the blood, but by  abstracting a
portion of its fluid parts, and thus reducing the action of
the blood-vessels.    This mode cf curing fever is  still
fashionable in  genteel life.   It excites no fear, and offends
no sense.   The sweating remedies have been numerous,
and fashion has reigned as much among them,  as in other
things.   Alexipharmic waters,  and powders, and all the
train of sudorific medicines, have lately yielded to the
different preparations of antimony, particularly to James's
powder.  I object to them all,
   1. Because they  are uncertain;  large and repeated
doses of them being often given to no purpose.
  2. Because they are slow and disagreeable, where they
succeed in curing lever.
  3. Because, like vomits and purges, they are not under
the direction of a physician,  widi respect to the quantity
of fluid discharged by them.
  4. Because they  are sometimes,  even when most pro-
fuse, ineffectual in the cure of fever.
  5. The preparations of antimony, lately employed for
the purpose of exciting sweats, are by no means safe.
 They sometimes convulse the  system  by a violent pukl
ing.   Even the boasted James's powder has done great
mischief.   Dr. Goldsmith and Mr.  Howard,  it is said,
were destroyed by  it.
  None of these objections to sweating remedies are in«
tended to dissuade from thtir use,  when nature shows a
disposition to throw off a fever by the pores of the  skim
but, even then, they often require the aid ol bleeding to
render them effectual for that purpose.
   IV.  Mercury, the Sampson of die materia medica, after
having subdued the venereal disease, the tetanus,  arid 
DEFENCE OF BLOOD-LETTING.        193
many other  formidable diseases, has lately  added to its
triutnphsandreputauon, by overcoming the inflammatory
and malignam state of fever   I shall confine  myself, in
this place, to its depie ing operation, when it acts" by ex-
citing a salivation.  From half a pound to two pounds of
fluid are discharged by it in a day. The depletion in this
way is gradual, whereby fainting is  prevented.  By ex-
citing and inflaming the glands of the mouth  and throat,
excitement  and  inflammation  are abstracted from more
vit.'.l parts.  In morbid congestion and excitement in the
brain, a salivation is of eminent service,  from the prox-
imity of the discharge of the part affected.  But I object
to it, as an exclusive vacuant in the  cure of fever,
   1. Because it is sometimes impossible, by  the largest
doses of mercury, to excite it, when the exigences of the
system render it most necessary.
   2. Because it is not so quick in its operation, as to be
proportioned to the rapid progress of the malignant  state
of fever.
   3.  Because it  is  at all times a disagreeable, and fre-
quently a painful remedy,  more especially where the  teeth
are decayed.
   4. Because it  cannot be proportioned in its duration,
or in the quantity of fluid discharged by it, to the violence
or changes in the fever.
   Dr. Chisholm  relied, for the cure of the Beullam  fever
at Grenada, chiefly  upon  this  evacuation.  I  have  men-
tioned the ratio of success which attended it.
   V. Blisters are  useful in depleting  from those  parts
which are the seats of topical inflammation.  The re-
Kef obtained  by them  in this way more  than balances
their stimulus upon the  whole system.  I need hardly
say, that their effects in reducing the morbid and exces-
sive action of the blood-vessels are  very feeble.  To de-
pend upon them in  cases of great inflammatory action, is
as unwise as it would be to attempt to bale the water  from
a leaky and sinking ship  by the hollow of the hand, in-
stead of discharging it by two or three pumps.
   VI  Abstemious diet  has sometimes  been prescribed
as a remedy for fever.   It acts directly by the  abstraction
of the stimulus of food from the stomach, and indirectly
   VOL. IV.              b b 
194         DEFENCE OF BLOOD-LETTING.

by lessening the quantity of blood.  It can bear no pro-
portion, in its effects, to the rapidity, and violence of an
inflammatory fever.   In chronic fever, such as occurs in
the pulmonary consumption, it has often been tried to no
purpose.  Long before it reduces the pulse, it often in-
duces such  a  relaxation of the tone of the stomach and
bowels as to accelerate death.  To depend upon it there-
fore in the cure of inflammatory  fever, whether acute or
chronic, is  like trusting to the  rays of the sun to exhale
the water of an overflowing tide, instead of draining it off
immediately, by digging a hole in the ground. But there
are cases in which the blood-vessels become so insulated,
that they refuse to yieid their morbid excitement to de-
pletion from any outlet,  except from themselves.   I at-
tended a sailor, in the Pennsylvania hospital, in 1799, who
was affected with deafness, attended with a full and tense
pulse.   I prescribed for it, purging, blisters, and low diet,
but without any effect.   Perceiving no change in his
pulse, nor in his disease, from those remedies, I ordered
him to lose ten ounces of blood.   The relief obtained by
this evacuation induced me to repeat it. By means of six
bleedings he was perfectly cured, without the aid of any
other remedy.
  Bleeding has great advantages  over every mode of de-
pleting  that has been mentioned.
   1. It abstracts one of the exciting causes, viz. the stim-
ulus of the blood  from the seat of fever.  I have formerly
illustrated this advantage of blood-letting, by comparing
it to the abstraction  of a grain of sand from  the  eye to
cure an opthalmia.   The other depleting remedies are as
indirect and circuitous in their operation in curing fever,
as vomits and  purges would be to remove an inflamma-
tion in the eye, while the grain of sand continued to irri-
tate it.
   2. Blood-letting is quick in its operation, and may be
accommodated to the rapidity of fever, when it manifests
itself in apoplexy, palsy, and syncope.
   3. It is under the command of a physician.  He may
bleed when  and where he pleases, and may suit the quan-
tity of  blood  he  draws, exactly to the  condition of his
patient's system. 
DEFENCE OF BLOOD-LETTINC
195
  4. It may be performed with the least attendance of
nurses or friends. This is of great importance to the poor
at all times, and to the rich during the prevalence of mor-
tal epidemics.
  5. It disturbs  the system  much less than any of the
other modes of depleting, and therefore is best accommo-
dated to that state of the system, in which patients are in
danger of fainting or dying upon being moved.
  6. It is a more delicate depleting remedy than most of
those which have  been mentioned,  particularly  vomits,
purges, and a salivation.
  7. There is no immediate danger to life from its use.
Patients have sometimes died under the operation of vo-
mits and purges, but I never saw nor heard an instance
of a patient's dying in a fainty fit, brought on by bleed-
ing.
  8. It is less weakening, when used to the extent that
is necessary to cure, than the same degrees of vomiting,
purging, and sweating.
  9. Convalescence is more rapid and more perfect after
bleeding, than after the successful use of any of the other
evacuating remedies.
  By making use  of blood-letting in fevers, we are not
precluded from the benefits of the other evacuating re-
medies.  Some of them are rendered more certain  and
more effectual by it, and there are cases of fever, in which
the combined or successive application of  them all is
barely sufficient to save life.
  To rely  upon any one evacuating remedy, to the ex-
clusion of the others, is like trusting to a pair of oars in a
sea voyage, instead of spreading every sail of a ship.
  I suspect the disputes about the eligibility of the dif-
ferent remedies which have been mentioned, have arisen
from an ignorance that they belong to one class, and that
they differ only in their force and manner of operation.
Thus the physicians of the last centurv ascribed different
virtues to salts of different names, which  the chemists of
the present day have taught us are exactly the same, and
differ only in the manner of their being prepared.
  Having replied to the principal objections to blood-let-
ting, and stated its comparative advantages over  other 
196        DEFENCE OF BLOOD-LETTING.

modes of depletion,  I proceed next to mention the  cir-
cumstances which should regulate the use of it.  These
are,
  I. The state of the pulse.
  The following states of the pulse indicate the necessity
of bleeding.
   1. A full, frequent and vigorous pulse without tension,
such as occurs  in the yellow fever, gout and apoplexy.
I have called it the synochus fortis pulse.
   2. A full, frequent, and tense pulse, such as occurs in
the pulmonary, rheumatic, gouty, phrenitic, and mania-
cal states of fever.
   3. A full, frequent, and jerking pulse, without tension!
such  as frequently  occurs  in the vertiginous, paralytic,
apoplectic, and hydropic states of fever.
   4. A small, frequent, but tense pulse, such as occurs
in the  chronic pulmonary, and rheumatic states of fever.
   5. A tense and quick pulse, without much preternatu-
ral frequency.  This state of the pulse is common in the
yellow fever.
   6.  A slow  and tense pulse, such as occurs in the apo.
plectic, hydrocephalic, and malignant states of fever, in
which its strokes are from 60 to 90 in a minute.
   7.  An uncommonly frequent pulse, without much ten-
 sion, beating from 120 to 170 or 180 strokes in a minute.
   This state of the pulse occurs likewise in the malignant
 states  of fever.
   8.  A  soft pulse, without much frequency or fulness. I
 have met with this state of the pulse in affections of the
 brain, and in that state of pulmonary fever which is known
 by the name  of pneumonia notha.  It sometimes, 1 have
 remarked, becomes tense after bleeding.
   9. An intermitting pulse.
   10. A depressed pulse.
   11. An imperceptible pulse.   The slow, intermitting,
 depressed, and imperceptible states of the pulse are sup-
 posed exclusively to indicate congestion in the brain. But
 they are all,  I believe, occasioned likewise by  great ex-
 cess of  stimulus acting upon the heart and arteries.  A
 pulse more tense in  one arm than in the other, I have gene-
 rally found to attend a morbid state of the brain.  Much,
 yet remains to be known of the signs of a disease in the 
           defence of blood-letting.         197

brain, by the states of the pulse;  hence Mr. Hunter has
justly remarked, that "In inflammation of the brain, the
pulse varies more than in inflammaiions ot any other part;
and  perhaps we are led to judge of inflammation  there,
more from other symptoms than the pulse."*
   The slow, uncommonly frequent, intermitting, and im-
perceptible  states  of the pulse, which require bleeding,
may be distinguished from the same states of the  pulse,
which arise from an exhausted state of the system, and
that forbid bleeding, by the following marks:
   1. They occur in the beginning of a fever.
   2. They occur in the paroxy sms of fevers which have
remissions and exacerbations.
   3. They sometimes occur after  blood-letting,  from
causes formerly mentioned.
   4. They sometimes occur, and continue during ^the
whole course of an inflammation of the stomach and bow-
els.  And,
   5. They occur in relapses, after the crisis of a fever.
   The other stages of the pulse indicate bleeding in every
 stage of fever, and in every  condition of the system.  I have
 taken notice, in another place, of the circumstai ces which
 render it proper in the advanced  stage of chronic fever.
   If all the states of pulse which have been enumerated
 indicate bleeding, it must be an affecting consideration to
 reflect, how many lives have been lost, by physicians limit-
 ing the use of the lancet only to the tense or full pulse!
  :  I wish  it comported with the proposed limits of this
 essay to illustrate and establish, by the recital of cases, the
 truth of these remarks, upon the indications of bleeding
 from the pulse.  It  communicates much more knowledge
 of the state of the  system than any other sign of disease.
 Its frequency (unconnected with its other states,) being un.
 der the influence of diet, motion, and the passions of the
 mind, is of the least consequence.  In counting the num-
 ber of its strokes, we are apt to be diverted from attending,
 to its irregularity and force; and  in these, it should always
 be remembered, fever chiefly consists.   The knowledge
 acquired  by attending to these states of the pulse is so
 definite and useful, and the  circumstances which seduce
 from a due attention to them are so erroneous in their in-
 dications, that I have sometimes wished the Chinese cus-
               • Treatise on Inflammation, chap. iii. 9. 
 198         DEFENCE OF BLOOD-LETTING.

 torn of prescribing, from feeling the pulse only, without
 seeing or conversing with the patient, were imposed upon
 all physicians.
   To render the knowledge of the indications of blood-
 letting, from the state of the pulse, as definite and correct
 as possible,  I shall add, for the benefit of young practi-
 tioners, the following directions for feeling it.
 p  1.  Let the arm be placed in a situation in which all the
 muscles which move it  shall be completely relaxed; and
 let it,  at the same time, be free from the pressure of the
 body upon it.
   2.  Feel the pulse, in all obscure or difficult cases,  in
 both arms.
   3.  Apply  all the fingers of one hand, when practicable,
 to the pulse.  For this  purpose, it will  be most conve-
 nient to feel the pulse of the right hand with your left, and
 of the left hand with your right.
   4.  Do not decide upon blood-letting, in difficult cases,
 until you  have felt the  pulse for some time.   The Chi-
 nese physicians never prescribe until they have counted
 49 strokes.
   5.  Feel the pulse at the intervals of four or five min-
 utes, when you suspect that its force has been varied by
 any circumstances  not connected with the disease, such
 as emotions of the mind, exercise, eating, drinking, and
 the like.
   6. Feel the pulsations of the arteries in the temples and
 in the neck, when the pulse is depressed or imperceptible
 in the wrists.
   7. Request silence in a sick room, and close your eyes,
 in feeling a pulse in difficult cases.   By so doing, you
 will concentrate  the sensations of your ears and eyes, in
 your fingers.
   In judging of  the states of the pulse which have been
 enumerated, it will be necessary always to remember the
natural difference, in its frequency and force,  in old peo-
ple and children;  also in the morning and  evening, and in
the sleeping and waking states of the system.
   Much yet  remains to be known upon this subject.   I
have mentioned the different states of the pulse which call
for bleeding,  but  it is more difficult to know when to pre-
scribe it, when the pulse imparts no sign of disease.  In 
DEFENCE OF BLOOD-LETTING.
199
general it may be remarked when  the disease is recent,
the part affected important to life, and incapable of sus-
taining  violent  morbid action long, without danger of
disorganization, where pain is great, and  respiration diffi-
cult, where there is  redness in the face, and  a watery,
lively, or suffused eye,  the pulse may be disregarded in
the use  of the lancet.  To these signs,  Dr.  Sydenham
adds, in the history of the case  of a  lady in whom the
pulse gave no indication  of the force of the disease, " a
red colour in the cheeks;  drops of blood  issuing from the
nose, no diminution of the heat of the body after  bleed-
ing, and the existence of  an  inflammatory constitution of
the atmosphere."*
   But to return.
   II. Regard should be had to the character of the reign-
ing  epidemic, in deciding upon blood-letting.   If the
pre vailing fever be ot a highly inflammatory nature, bleed-
ing  may be used with more safety,  in cases  where the
indications of it from the pulse are somewhat doubtful.
The character of a previous epidemic should likewise di-
rect the use of the lancet.   The pestilential fever which
followed the plague in London, in  1665, Dr. Sydenham
says, yielded only  to blood-letting.   It  is equally neces-
sary in all the febrile diseases which succeed malignant
 fevers.
   III.  Regard should be had to the season of the year,
 and to the state of the weather.  It is more copiously in-
 dicated in the  winter and  spring,  than in summer and
 autumn  in middle latitudes, and Dr.  Hillary and  Dr.
 Huxham both say,  it is  more necessary in dry,  than in
 moist weather.
   The words of Dr. Huxham upon  this subject are as
 follow,  u Diseases even  of  the same species  (as 1 have
 constantly observed) require much larger  bleeding, and
 the sick bear it much better in dry  weather,  when the
 barometer stands high, than when a hot moist air almost
 destroys the tone of the vessels.    This  is  constantly ob-
 servable even in diseases of the breast.f"   The advan-

   • Wallis's edition, vol. i. 134.
   t Observations upon the Air, and Epidemic Diseases* preface, page xxviii. 
 200        DEFENCE OF BLOOD-LETTING.

 tages of copious bleeding in the yellow fever of 1793,
 when the  weather was uncommonly dry, confirms the
 truth of the remarks of  those  excellent practical physi-
 cians.
   IV. The constitution of a patient, and more especially
 his habits with respect to blood-letting, should be taken
 into consideration, in prescribing it.   If he be plethoric,
 and accustomed to  bleeding in former indispositions, it
 will be more necessary, than in opposite states and habits
 of the system    Nature will expect it.
   V. The corpulency of a patient should regulate the use
 of the lancet.   A butcher of great observation informed
 me, that a fat ox did not yieid  more than from one half,
 to one third of the quantity of blood of a lean one, of the
 same size of bone, and it is well known that the loss of
 a small quantity of blood, after cutting off ihe head of a
 fowl, is always a sign of its being fit for the table.  The
 pressure of fat upon the  blood-vessels produces the same
 effects in the human species that it dots in those animals;
 of course, less blood should be drawn from fat, than from
 kan people, under equal  circumstances of disease.
  VI. As  persons have more or  less blood in their ves-
 sels, according to their size, less blood should be drawn,
 under equal circumstances, from small than large people.
  VII. Regard should be had to the age of adults in pre-
 scribing bleeding. In persons between fifty and sixty years.
 of age, for reasons formerly mentioned, more blood may
 be drawn than in middle life,  in  similar diseases.  In
 persons beyond  70, it will be necessary to regulate the
 quantity to be drawn  by other signs than the pulse, or the
 appearances of the blood, the former being generally full,
 and sometimes tense, and the  latter often putting on the
 sign of the second grade of morbid action formerly de-
 scribed.
  Vill.  Regard should be had to the  country or place
 from  which persons affected with  fevers  have  arrived,
 in prescribing the loss of blood.   Fevers, in America,
 are  more inflammatory than fevers, in  persons of equal
rank, in Great-Britain.  A French physician  once said,
 it was safer to draw a hogshead of  wine from a  French-
 man's veins, than a quarter of a hundred pounds of beef 
            DEFENCE OF BLOOD-LETTING.       201

from an Englishman's,  meaning to convey an idea of the
difference in the grades  of morbid or inflammatory action
in the diseases of the inhabitants of France and England,
and of the difference of the quantity of blood proper to be
drawn in each of them. A similar difference exists betw een
the grades of fever in Great-Britain and America.  From
a want of attention to this circumstance, I saw a common
pleurisy end in an abscess of the lungs, in a sea captain,
in the city of London, in the year 1769, who was attend-
ed by a physician of the  first reputation in England.   He
was bled but once.  His pulse and American constitution
called for the loss of 50 or 60 ounces of blood.   My for-
mer pupil, Dr. Fisher, in a  letter from  the university of
Edinburgh dated in the winter of 1795, informed me,
that he  had cured several of his American fellow students
of fevers, contrary to the general prejudices and practice
in that city, by early bleeding, in as easy and summary a
way as he had been, accustomed to see them cured in Phila-
delphia  by the same remedy. It is not less true, and wor-
thy of the attention of an American  physician,  that the
diseases of new comers into the United States from Great-
Britain,  Ireland,  and other  European countries, require
more bleeding than the natives or old settlers, under equal
circumstances of disease.   This fact struck the late Dr.
Reynolds in a very forcible manner, in his extensive prac-
tice among his newly arrived fellow citizens from Ireland.
The remark is founded  on reason, and it is to be wished,
those European physicians who charge their patients when
th'ry are about to emigrate to America,  " never to be
bled," would consider how much  the change which the
stimulating impressions  of a new  climate,  diet,  com-
pany, and often of employments, make upon the system,
is opposed to their advice.
  IX.  Regard should be had to the structure and situa-
tion of the parts diseased with febrile action.  The brain,
from its importance to all the functions of life, the rectum,
the bladder, and the trachea, when inflamed, and the in-
testines, when strangulated, from their being removed  so
much out of the influence of the great circulation, all re-
quire more copious bleeding than the same degrees  of
disease  in the lungs, and some other parts of the body.
   vol. iv.              c c 
20ii        DEFENCE  OF BLOOD-LETTt 1\TCV

   X. After blood-letting has been performed, the appear*
ances of the blood should be attended to, in order to judge
of the propriety of repeating it.    I shall briefly describe
these appearances, and arrange them in the order in which
they indicate the different degrees of inflammatory dia-
thesis, beginning with the highest.
   1.  Dissolved blood.   It occurs in the malignant states
of fever.  I have seen it several times in the pleurisy, and
have  once heard of it in a ease of gout.   I have ascribed
this decomposition of the blood to such a violent, or fee-
ble degree of action  in the blood-vessels as to dispose
them to a paralytic state.  It  is generally considered as a
signal to lay aside the lancet. If it occur in ihe first stage
of a fever, it indicates a very opposite practice.    By re-
peated bleedings, the* vessels recover their natural action,
and  the blood  becomes resuscitated, or reduced to its
original texture.  Of this I have had frequent experience*
since the year 1793*  It required three successive bleed-
ings to  restore the blood from a dissolved, to a coagula-
ble state, in Mr. Benton.  It afterwards became  very
sizy.  If this dissolved blood appear  towards the close
of a malignant fever, no other benefit than the protraction
of life for a day  or two, or an easy death, can be expected
from  repeating the bleeding, even though it  be indicated
by a tense pulsej for the viscera  are generally so much
choaked by the continuance of violent action in the blood*
vessels, that they are seldom able to discharge the blood
which distends them, into the cavity in the vessels, which
is created by the abstraction of blood from a vein.   There
is some variety in the appearance of this state  of the blood?
which indicates more  or less  violent pressure Upon the
blood vessels.   It threatens most danger to  life  when it
resembles molasses in its consistence.  The danger is less
when the part which is dissolved occupies the bottom of
the bowl, and when its surface is covered  with a  sizy
pellicle  or coat.   I have said the blood is sometimes dis-
solved from a too feeble action of the blood-vessels upon
it. We observe this in the scurvy and in the lowest grade
Of typhus fevef.   It is restored in  these eases to its natural
consistence by means of stimulating remedies.    To this
account of the morbid  state of the blood, it may not be
improper to add, that Dr. Stoll found it coagulated in the 
DEFENCE OF BLOOD-LETTING.       203
veins of an epileptic patient, and that Morgagni mentions
the case of a girl in whom the blood was cold.  She had
at the same time no sense of coldness in any part of her
body.  By means of stimulants, she was recovered.
   Does not the  restoration of the blood from its disor-
ganized state, by means of bleeding, suggest an idea  of
a similar change being practicable in the solids, when they
arc disorganized by disease?  And are we not led here-
by to an animating view of the extent and power of me-
dicine?
   2.  Blood of  a scarlet colour, without any  separation
into crassamentum or serum, indicates a second degree of
morbid action.  At occurs likewise  in the malignant state
of fever.   It is called improperly dense blood.  It occurs
in old people.
   3.  Blood in which part of the crassamentum is dissolv-
ed in the serum, forming a resemblance to what is called
the lotura carnium, or the washings of flesh in water.
   4.  Serum of a clear red,  or green colour.   The vio-
lence and danger of fevers in which the serum of the blood
assumes the latter colour, is taken notice of by Dr. Hux-
ham.*
   5. Crassamentum sinking to the bottom of a  bowl  in
yellow serum.
   6. Crassamentum floating in serum, which is at first
turbid, but which afterwards  becomes yellow and trans-
parent, by depositing certain red and fiery particles of the
blood in the bottom of the bowl.
   7. Sizy blood, or blood covered with a buffy coat.  The
more the crassamentum appears in the form of a cup, the
more inflammatory action is said to be indicated by  it.
This appearance of the blood occurs in all the common
states of inflammatory fever.   It occurs too  in the mild
state of malignant fevers, and in the close of such of them
as have been .violent.  It is not always confined to the
common inflammatory state of the pulse, for I have ob-
served it occasionally in most of the different states of the
pulse which have been described.   The appearance of
this buffy coat on the blood in the yellow fever is always
favourable.  It shows the disease to be tending  from  an
             •OaAir and Epidemics, vol. i. p. 129. 
204        DEFENCE OF  BLOOD-LETTING.

uncommon to a  common  degree of inflammatory diathe-
sis.   It has been  remarked, that blood which  resembles
claret  in  its  colour,  while flowing, generally puts  oty
when it cools, a sizy appearance.   Blood which assumes
a paler red colour near the edges of the bowl, than that
which is in the middle of  the bowl into which it is flow-
ing,  is likewise generally sizy.
  It would seem, from these facts, that the power of co-
agulation of the blood was lessened in an exact ratio to
the increase of action upon the blood-vessels, and that it
was increased in proportion to the diminution  of that ac-
tion, to that degree of it which constitutes what I have
called common inflammatory action.
  Here, as upon a former occasion,  we may say with
concern, if bleeding be indicated by all the appearances
of the blood  which have  been enumerated,  how  many
lives have been lost by physicians limiting the use of the
lancet to those cases only, where the blood discovered an
inflammatory crust!
   It would bt a digression from the subject now under
consideration, or I would  add in this place some remarks
upon what is called the vitality of the blood.  I shall only
mention, that I have for many years taught in my physio-
logical lectures that the blood in the healthy state appears
to be like the bones and  tendons, animalized only,  and
that like those parts of the body, it  besomes animated
by the stimulus of disease.  The more sizy it becomes,
the more it partakes of an animated quality.   Its cupped
appearance indicates  its having assumed a muscular na-
ture.  It is in this animated state  of the fibrin only, that
it forms those membranes which  succeed inflammation
in different parts  of the body.
   The remarks which have been delivered upon the rela-
tive signs of inflammatory- action in the blood-vessels,
should be admitted with  a recollection that they are all
liable to be varied by a moderate, or violent exacerbation
of fever, by the size of the stream of blood, and by the
heat, coldness, and form of the cup into which the blood
flows.  Even blood drawn, under exactly equal circum-
stances, from both arms, exhibited, in a case of pleurisy
communicated to me by Dr. Mitchell, of Kentucky, very 
           DEFENCE OF BLOOD-LETTING.       205

different appearances.  That which was taken from one
arm was sizy, while that which was taken from the other
was of a scarlet colour.   I have known a similar differ-
ence to occur in the appearances of the  blood in preg-
nancy.  That which was taken from the arm of the right
side,  was  much more sizy than that which was taken
from the left.  Blood which is drawn from  a vein in the
arm, puts on, likewise, appearances very different from
that which is discharged  from the bowels, in a dysentery.
These facts were alluded to in the Outlines of the Phe-
nomena of Fever,* in order to prove that unequal excite-
ment  takes place, not only in the different systems of the
body, but in the same system, particularly  in the blood-
vessels.  They  likewise  show us the necessity of attend-
ing to the state of the pulse in both arms, as well as  in
other  parts  of  the body,  in  prescribing blood-letting.
When time, and more attention to  that index of the state
of the system in fevers,  shall  have brought to  light  all
the knowledge that the pulse is capable of imparting, the
appearances of  the blood, in fevers, will be regarded  as
little as the appearances of the urine.
   XI. Biood-letting should always be  copious where
there is danger  from sudden and great congestion  or
inflammation, in vital parts.  This danger is indicated
most commonly by pain;  but there may  be  congestion
in the lungs, liver, bowels, and even in the  head, without
pain.  In  these  cases, the state of the pulse  should always
 govern the use of the lancet.  An advantage will arise in
these cases from drawing blood at the  same  time from
 both arms.  An alarm,  Mr. Hunter says, is thereby ex-
 cited in the arteries, which  disposes  them to  contract
 more suddenly, and thus to relieve themselves of redun-
 dant blood.   Eight ounces drawn in two minutes in  the
 cases under consideration, give more relief than a much
 larger quantity   in a longer time.   The good effects of a
 large stream of blood in violent and inflammatory diseases
 did not escape Dr. Sydenham.  The reverse of this prac-
 tice should be followed  in fevers  of weak inflammatory
 action.
• Vol. iii. 
206        DEFENCE OF BLOOD-LETTING.
   XII. What  quantity of blood  may  be taken, with
safety, from  a  patient in an  inflammatory  fever?  To
answer this  question it  will  be necessary  to remark,
1. That, in a person of an ordinary size,  there are suppo-
sed to be contained between 25 and 28 pounds of blood;
and,  2. That much more blood may be taken when the
blood-vessels are in a state of a morbid excitement and
excitability, than at any other time.   One of the uses of
the blood is to  stimulate the blood- vessels, and  thereby
to assist in originating and preserving animal life.   In a
healthy state  of the vessels, the whole mass of the blood
is necessary for this purpose;  but in their state of mor-
bid excitability, a much less quantity of blood than what
is natural (perhaps in some cases four or five pounds)
are sufficient to keep up an equal  and vigorous circula-
tion.   Thus  very small portions of light  and sound are
sufficient to excite vision and hearing, in an inflamed and
highly excitable state of the eyes and ears.  Thus too, a
single glass of wine will often produce delirium in a fever
in a man, who, when in health, is in the habit  of drinking
a bottle every day,  without having his pulse quickened
by it.
   An ignorance of the quantity of blood which has been
drawn by design,  or lost by  accident,  has  contributed
very much to encourage prejudices against blood-letting.
Mr.  Cline drew 320 ounces of blood in 20 days from a
patient in St. Thomas's hospital,  who laboured under a
contusion of the head.   But this quantity is small com.
pared with the  quantity  lost by a number cf persons,
whose cases are recorded by Dr. Haller.*   I shall men-
tion a few of them.  One person lost 9 pounds of blood,
a second 12, a  third 18, and a fourth 22, from the nose,
at one time.  A fifth lost 12 pounds by vomiting in one
night, and a  sixth 22 from the lungs.   A gentleman  at
Angola lost between 3 and 4 pounds daily from his nose.
To cure it, he was bled 97 times in one year.  A young
woman was bled 1020 times in 19 years,  to cure her of
plethora which disposed her to hysteria.  Another young
woman lost 125 ounces of blood, by a  natural haemor-
rhage, every month.   To cure it, she was bled every day,
            * Elementa Physioiogiae, vol. iv. p. 45. 
DEFENCE OF BLOOD-LETTING-
207
«hd every other day, for 14 months.   In none of these
instances was death the consequence of these great evacu
ations of blood.  On the contrary, all the persons alluded
to, recovered.   Many similar instances of the safety, and
even benefit of profuse discharges of blood, by nature and
art, might be mentioned from other  authors.  I shall in-
sert only one more, which shall be taken from Dr. Syden-
ham's account of the cure of the plague.   *• Among the
other calamities of the civil war which afflicted this  nation,
the plague also raged in several places, and was brought
by accident from another place to Dunstar Castle, in So-
mersetshire, where some of the soldiers dying suddenly,
with an eruption of spots, it likewise seized several others.
It happened at that time that a surgeon,  who had travel-
led much in foreign parts, was in the  service there, and ap-
plied to the governor for leave to assist his fellow-soldiers
who were afflicted with this dreadful disease, in the best
 manner he was able;  which  being  granted, he  took so
 large a quantity of blood from every one at the beginning
 of the disease, and before any swelling was perceived, that
 they were ready to faint, and drop down, for he bled them
 all standing,  and in the open air, and had no vessel to
 measure  the blood, which falling on  the ground, the quan-
 tity each  person lost could not of course be known.   The
 operation being over, he ordered them to lie in their tents,
 and though he'gave no kind of remedy after bleeding, yet
 of the numbers that were thus treated, not a single person
 4ied.  I had this relation from  Colonel Francis Wind-
 ham, a gentleman of great honour and veracity, and at this
 time governor of the castle."*
   Again.  An ignorance of the rapid manner in which
 bio-oil is  regenerated,  when lost or  drawn, has helped to
 keep up prejudices against blood-letting.   A person (Dr.
 Haller says) lost  five pounds of blood  daily from the
 hemorrhoidal vessels for 62 days, and another 75 pounds
 of blood in 10  days.   The loss each day, was supplied
 by fresh quantities"of aliment, and where no aliment is ta-
 ken into the stomach, by the blood that is prepared from
 the chyle which is secreted in the liver from the fat of the
 omentum.   I have supposed in my  physiological lectures
  ;hat the omentum performs the vicarious purpose that has
                     • Vol. i. p. 131. 
203         DEFENCE OF BLOOD-LETTING.

been mentioned.   This opinion has been defended and
applied to practical purposes by my son Dr. James Rush,
in his  inaugural dissertation published in April  1809.
One of the inferences drawn from it, is a caution not to
lay aside the lancet in chronic diseases with inflammatory
symptoms,  from a fear  of a penury of blood,  incases.
where  the resources for its reproduction have failed from
the abstraction of food, or a deficiency of the functions of
the stomach, and where the liver retains the chylopoetic
office he has ascribed to it.       •  x
   These facts, I hope, will be sufficient to establish the
safety  and advantages of plentiful blood-letting, in cases
of violent fever; also to show the fallacy and danger of
that  practice which  attempts the cure  of such cases of
fever, by what is called moderate bleeding.  There are,  it
has been said, no half truths in government. It is equally
true, that there are no half truths in medicine.   This half-
way practice of moderate bleeding, has kept up the mor-
tality of pestilential fevers, in all ages and in all countries.
I have combated this practice  elsewhere,* and have assert,
ed upon the authority of Dr. Sydenham, that it is much
better not to bleed at all, than to draw blood disproportion-
ed in quantity to the violence of the fever.   If the state of
the pulse be our guide, the continuance of its inflamma-
tory action, after the loss of even  100 ounces of  blood,
indicates the necessity of more bleeding, as much as it did
the first time a vein was opened.  In the use of this reme-
dy it may he truly said, as in many of the  enterprizes of
life, that nothing is done, while any thing  remains to be
done.   Bleeding should be repeated while the symptoms
which  first indicated it continue, should it be-until four-
fifts of the blood contained in the body are drawn aw«y.
In this manner we act in the use of other remedies.  Who
ever leaves off giving purges in a colic, attended with cos-
tiveness, before the bowels are opened? or who lays aside
mercury as a useless medicine, because a few doses of it
do not cure the venereal disease?
   I shall only add under  this head, that I have always
observed the cure of a malignant fever to be most com-
plete, and the convalesence to be most rapid, when  the
bleeding has been continued until a paleness is  induced
              * Account of the Yellow Fever in 1T93. 
            DEFENCE OF BLOOD-LETTING.        209

in the face, and until the patient is able to sit up without
being fainty.   After these circumstances occur, a mode-
rate degree of force in the pulse will gradually wear itself
away, without  doing any harm.
   XIII. In drawing blood, the quantity should be  large
or small at a time, according to the state of the system.
In cases where the  pulse acts  with force  and freedom,
from  10 to 20 ounces of blood may be taken at once; but
in cases where  the pulse is  much depressed,  it  will be
better to take away but a few ounces at a time, and to
repeat it three or four times a day.  By this  means the
blood-vessels more gradually recover their vigour, and
the apparent bad effects of bleeding are thereby prevented.
Perhaps the same advantages might be derived in many
other cases, from the gradual abstraction of stimuli, that
are derived from the gradual increase  of their force and
number, in their application to the body.   For a number
of facts in support of this practice, the reader is referred to
the history of the yellow fever, in the  year 1793.   In an
inflammatory fever, the character of which is not  accu-
rately known,  it is safest to begin with moderate bleed-
ing, and to increase it in quantity, according as the vio-
lence and duration of the disease shall make it necessary.
In fevers, and other diseases, which run their courses in
a few days or  hours, and which threaten immediate dis-
solution, there can be no limits fixed  to the quantity  of
blood which may be drawn at once, or in a short time.
Botallus drew  three, four and five pints in a day, in such
cases.  Dr.  Jackson drew fifty-six ounces of blood at one
time, from a Mr. Thompson, of thev British hospitals,  in
 a fever of great violence and danger.   This  patient was
 instantly relieved from what he styled  " chains and hor-
 rors."  In three or four  hours he was  out of danger, and
 in four days, the doctor adds, returned to his duty.* Dr.
 Physick drew ninety ounces, by weight, from Dr. De-
 wees, in a sudden attack of the apoplectic state of fever,
 at one  bleeding, and thereby restored  him so speedily  to
 health, that he was able to  attend to his business in three
 days afterwards.   Under this head I shall  remark that

   • Remarks on the Constitution of the Medical Department  of the British
 Army.
    VOL. IV.              D d 
210        DEFENCE OT  BLOOD-LETTING.

bleeding ad deliquium animi is often attended with obvious
good effects in the first stage of violent diseases.  By the
total relaxation it induces in the blood-vessels, it enables
the stimuli which support animal life, to impart  to them
a new, and natural action, and thereby suddenly to restore
their equable excitement, but this mode of bleeding should
never be employed in the  advanced, or last stages of  fe-
ver.   I have once known death to be thus induced by it.
The system requires all its resources in excitability to be
restored from a fainting fit, and these  exist only  m the
early or acute stages of disease.  In chronic states of fever,
of an inflammatory type,  small and frequent bleedings,
are to be preferred to large ones.   We use mercury, an-
timony, and diet drinks as alteratives  in  many  diseases
with advantage.   We do  not expect to remove debility
by two or three  immersions in  a cold bath.  We persist
with patients in  prescribing all the  above remedies  for
months and years,  before we expect to reap the full be-
nefits of them.   Why  should  not blood-letting be used
in the same  way, and have the same chance  of doing
good?  I have long ago adopted the alterative mode of
using it, and I can now look around me, and with plea-
sure behold a number of persons of both sexes who owe
their lives to it.  In many  cases I have prescribed it once
in two or three months, for several years, and in some I
have advised it every two weeks,  for several months.
   There is a state of fever in which an excess in the  ac-
tion of  the blood-vessels is barely perceptible, but which
often threatens immediate danger  to life, by a determina-
tion of blood to  a vital part. In  this case I have frequently
seen the scale turn in favour of life, by  the  loss of but
four or live ounces of blood.  The pressure  of  this, and
even of a much less quantity of blood in the close of a
fever, I believe,  as effectually destroys life as the  excess
of several pounds does  in its beginning.  The advantage
to be derived from the loss of a small quantity  of blood
in certain stales of the system is obvious, from the sudden
relief which the  discharge of a  few ounces of blood  by
menstruation affords to the pains which sometimes attend
that monthly disease. 
DEFENCE OF BLOOD-LETTING.
211
  In cases where bleeding docs not cure, it may be used
with advantage as a palliative remedy.   Many diseases
induce death in a full and highly excited state of the s\ s.
teni. Here opium does harm, while bleeding affords cer-
tain relief.   It belongs to this remedy, in such cases, to
ease pain, to prevent convulsions, to compose  the mind,
to protract the use of reason, to  induce sleep,  and thus
to smooh the passage out of life.
  XiV.  Bleeding from au artery, commonly called arte-
riotomv, would probably  have many advantages over ve-
nesection, couid it be performed at  all  times  with ease
and siuety.  Blood discharged by  haemorrhages  affords
more relief, in fevers, than an equal quantity drawn from
a vein, chiefly because it is poured forth, in the  former
case, from a ruptured artery. I mentioned formerly, that
Dr. Mitchell had found blood drawn from an artery to be
what is called dense, at a time when that which was drawn
from a vein, in the same persons, was dissolved.  This
fact may possibly admit of some application. In the close
of malignant fevers,  where bleeding has been  omitted in
the beginning of the disease, blood drawn from a vein is
generally so dissolved, as to be beyond the reach of repeat.
ed  bleedings to restore it to its natural texture.   In  this
case, artenotomy might probably be performed with ad-
vantage. The arteries, which retain their capacity of life
longer than the veins, by being relieved from the imme-
mediate pressure of  blood upon them, might be enabled
so to act upon the torpid veins, as to restore their natu-
ral  action, and thereby to arrest departing life.   Arteri-
otomy might further be used with advantage in children,
in whom it is difficult, and  sometimes  impracticable to
open a vein.  Besides these advantages, there are several
others which attend  this mode of drawing blood.  1. The
arteries being more irritable than the veins,  the abstrac-
tion of blood immediately from them, removes the sti-
mulus from the part which is the seat of  the  most irri-
tation or diseased action.  2. More blood can be taken
from the arteries without bringing on fainting, than from
the veins,  in consequence of the heart (on the  suspension
of  whose  actions fainting depends) driving  the blood
which moves it from the veins.   This is of great conse-
quence in the close  of fevers in which bleeding may be 
^12        DEFENCE OF BLOOD-LETTING.

necessary, but in which fainting is sometimes fatal.  It
may be used with greater safety for the  same  reason in
pregnancy, where there is a disposition to faint, the effect
of which is sometimes to induce abortion.  3. The ar-
teries when opened, are more apt to assume a morbid ac-
tion from the wound inflicted upon them than  the veins,
in consequence of which, a  diseased action is more easily
translated from an internal, to an external  and less  vital
part of the body.  4. More relief is obtained by the loss
of a small quantity of blood, from an artery than from a
vein.  These four remarks in favour of arteriotomy are
taken from Dr. Butler's thesis, published  in Edinburgh.
They  appear to be rational, but I can  say but  little in
support of them from my own experience.
   XV. Much has been said about the proper place from
whence blood should be drawn. Bleeding in the foot was
much used formerly, in order to excite  a revulsion  from
the head and breast;  but our present ideas of the circu-
lation  of the blood have taught  us, that it may be drawn
from the arm with equal advantage  in  nearly all cases.
To bleeding in the foot there are the following objections:
 1.  The difficulty of placing a patient in  a  situation fa-
vourable to it.  2. The greater danger of wounding  a
tendon in the foot than in  the arm. And,  3. The impos-
sibility of examining the blood  after it is  drawn;  for, in
this mode of bleeding,  the blood generally flows into  a
bason or pail of  water.
   Under this head I shall decide  upon  the  method of
 drawing blood by means of  cups and leeches, in the in-
 flammatory state of fever.  Where an inflammatory fever
 arises from local affection, or from contusion in the head
 or breast,  or from a morbid excitement in those, above
 other parts of the arterial  system, they may  be useful;
 but where local affection is a symptom  of general and
 equable fever only,  it can  seldom be necessary, except
 where bleeding from the arm has been omitted,  or  used
 too sparingly, in the beginning of a fever; by which means
 such fixed congestion often takes place, as will not yield
 to general bleeding.
    XVI. Much has been said likewise about  the proper
 time for bleeding in fevers.  It  may be used at all times. 
           DEFENCE OF BLOOD-LETTING.       213

when indicated by the pulse and other circumstances, in
continual fevers; but it should be used chiefly in the par-
oxysms of such as intermit. I have conceived this prac-
tice to be of so much consequence, that, when I expect a
return of the fever in the night, I request one of my pu-
pils to sit  up with my patients all night, in order to meet
the paroxysm,  if necessary, with the lancet.  But I de-
rive another advantage from fixing a centinel over a pa-
tient in a malignant fever.   When a paroxysm goes  off
in the night, it often leaves the system in a state of  such
extreme debility, as to endanger life.   In this case, from
five to ten drops of laudanum, exhibited by a person who
is a judge of the pulse, obviate this alarming debility, and
often induce easy and refreshing sleep.   By treating the
human body like a corded instrument, in thus  occasion-
ally relaxing or bracing the system, according to the ex-
cess or deficiency of stimulus, in those  hours  in which
death  most frequently occurs, I think  I have been the
means of saving several valuable lives.
   XVII. The different positions of the body influence
the greater or less degrees of relief which are obtained by
blood-letting.   Where there is a great disposition to syn-
cope, and where it is attended with alarming and distress-
ing circumstances,  blood should be drawn  in  a  recum-
bent posture, but where there is no apprehension or dread
of fainting, it  may be taken in a sitting posture. The re-
lief will be more certain if the patient be  able to stand
while he is bled, for by thus opposing the  gravity of the
blood, to the action of the heart, ihe quantity of it usually
sent to the head, is lessened. It is diminished likewise in
the larger blood-vessels by the abstraction of that portion
of it which is necessary to the excitement of the muscles
in a standing posture, and hence fainting, and all the good
effects we wish from it in the first stage of disease, may be
more easily obtained, and these too from the loss of a much
smaller quantity of blood. It should therefore be preferred,
where patients object to copious or frequent bleedings.
The  history of the success of this practice in the British
army, recently mentioned from Dr. Sydenham, furnishes
a strong argument in its favour.
   I regret that the limits I have fixed to this defence of
blood-letting will not admit of my applying the principles 
2H        DEFENCE OF BLOOD-LETTING.

which have been delivered, to all the inflammatory states
of fever.  In a future essay, I hope to establish its efficacy
in the maniacal state of fever.  I have said that madness
is the effect of a chronic inflammation in the  brain.  Its
remedy, of course, should be frequent and copious blood-
letting. Physical and moral evil are subject to similar laws.
The mad shirt, and all the common means of coercion,
are as improper substitutes for bleeding, in madness, as
the whipping-post and .pillory are for solitary confinement
and labour, in the cure of vice. The pulse should govern
the use of the lancet in this as well as in all the ordinary
states of fever. It is the dial-plate of the system.  But in
the misplaced states of fever,  the pulse, like  folly in old
age, often points at a different mark from nature.  In all
such  cases, we must conform our practice  to that which
has been successful in the reigning epidemic.   A single
bleeding, when indicated by this circumstance, often con-
verts a lever from a suffocated, or latent,  to a  sensible
state, and thus renders it a more simple and manageable
disease.
  It was  worthy of consideration here, how far local dis-
eases, which have been produced by fevers, might be
cured by  re-exciting the fever.  Sir William  Jones sa)S,
the physicians  in Persia always begin the cure of the lep-
rosy by blood-letting.*  Possibly this  remedy  diffuses
the disease through the blood-vessels, and thereby  ex-
poses it to be more easily acted upon by other remedies.
  ■ Having mentioned the states of fever in  which blood-
letting is indicated, and the manner in  which it should
be performed, I shall conclude this  inquiry by pointing
out the states of fever in  which  it is forbidden,  or in
which it should be cautiously or  sparingly  performed.
This  subject is of consequence,  and should be carefully
attended to by all who wish well  to the  usefulness and
credit of the lancet.
  1.  It is forbidden in that state  of fever, as well  as in
other diseases, in which there is reason to believe the brain
or viscera are engorged with blood, and the  whole system
prostrated below the point of re-action.  I have suggested
this caution in another place.f  The pulse  in these cases
is feeble, and sometimes scarcely perceptible,  occasioned
               • Asiatic Essays.       t Vol iii. 
            DEFENCE OF BLOOD-LETTING.       215

by the quantity of blood in the blood-vessels being re-
duced, in consequence of the stagnation of large portions
in the viscera.  By bleeding in these cases, we  deprive
the blood-vessels of ihe feeble remains of the stir ulus
which keep up their action, and thereby precipitate death.
The remedies here should be  frictions, and stimulating
applications to the extremities, and gentle stimuli  taLen
by the mouth, or injected into the bowels.  As  soon as
the system is a little excited  by  these  remedies,  blood
may be draan, but in small quantities at a time, and per-
haps only by means of cups  or  leeches  applied to the
seats of  conjestions of the blood.  After the vessels are
excited by the equable diffusion of the blood through all
dieir parts, it may with safety be drawn  from the arm,
provided it be indicated by the pulse.
   2.  It is seldom proper beyond the third day, in a ma-
lignant fever, if it has not been used on the days  previ-
ous to it, and for the same reason  that has been  given
under the former head.  Even the tension of the pulse is
not always a sufficient warrant to bleed, for in three days
in a fever which runs its course in five days,  the  disor-
ganization of the  viscera is so complete, that a recovery-
is scarcely to be expected from the lancet.   The  reme-
dies which  give the only chance of relief in this case,
are purges, blisters, and a salivation.
   3. Where fevers are attended with paroxysms,  bleed-
ing should be omitted or used with great caution, in the
close of those paroxysms.   The debility which accom-
panies the intermission of the fever is often so much in-
creased  by the loss of blood,  as  sometimes to endanger
life.
   4. Bleeding is  forbidden, or should be used cautiously
 in  that malignant state of fever,  in which a weak morbid
 action, or what Dr. Darwin calls a tendency  to inirrita-
 bility, takes place in the blood vessels. It is known by a
 weak and frequent pulse, such as occurs in the typhus fe-
 ver and in the plague in warm climates. I have often met
 with it in the malignant sore throat, and  occasionally  in
 the pleurisy and yellow fever. The remedies here  should
 be  gentle  vomits or  purges,  and afterwards  cordials.
 Should  the pulse be too much excited by them, bleeding
 may be used to reduce it. 
216       DEFENCE  OF BLOOD-LETTINC*

   5. It should be used sparingly in the  diseases of ha-
bitual drunkards.   The morbid action in such  persons,
though often  violent,  is  generally transient.  It may
be compared to a soap-bubble.  The arteries, by  being
often overstretched by  the stimulus of strong drink,  do
not alwa}-s  contract with  the diminution of blood, and
such patients often sink, from this cause,  from the exces-
sive use of the lancet.
   6. It has been forbidden after the suppurative process
has begun in local  inflammation.   It constantly' retards
the suppuration, when begun, in the angina tonsillaris,
and thus protracts that disease.  To this,rule there are
frequent exceptions.
   7. It should be omitted in pneumony, after copious ex-
pectoration has taken place.  This discharge is local de-
pletion, and, though slow  in its effects  compared with
bleeding, it serves the same purpose in relieving the lungs.
The lancet can only be required where great pain in cough-
ing, and a tense pulse, attends this stage of the disease.
   8. It may be omitted (except when the blood-vessels
are insulated)  in those  diseases in which  there is time to
wait, without danger to life, or future health, for the cir-
cuitous operation of purging medicines, or abstemious
diet.
   9. It should be  avoided, when it can be done without
great danger to life, where there  is a great and  constitu-
tional dread of the  operation;  also in persons predisposed
to fainting, where that  occasional effect of bleeding is not
desired.   In such  cases, it has sometimes done harm to
the patient, and injured the credit of the lancet.
   10.  There are cases in which sizy blood should not
warrant a repetition of blood-letting. Mr. White informs
ns, in the History  of the Bilious Fever which has lately
prevailed at Bath,  that  bleeding, in many cases, in which
this appearance of the blood took place,  was useless or
hurtful.   Sir John  Pringle says the same  unsuccessful
issue attended a second bleeding when the blood was sizy
in the  hospital fever.   In some  of the fevers of  our own
country, we sometimes see sizy blood followed by symp-
toms which forbid the repeated use of  the lancet,  but
which  yield to other depleting remedies, or to such as are
of a cordial nature.  I  have seen the same kind of blood, 
           DEFENCE OF  BLOOD-LETTING.       217

a few hours before death, in a pulmonary consumption,
and three days after a discharge of a gallon and a half of
blood from the stomach by vomiting.
  11. Even a tense pulse  does not always call for the  re-
peated use of the lancet.   I have mentioned one case, viz.
on the third or fourth days of a malignant fever, in which
it is improper.  There are instances of incurable consump-
tions from tubercles and ulcers in the lungs, in which  the
pulse cannot be made to feel the least diminution of ten-
sion by  either copious or frequent bleedings.  There  are
likewise cases of hepatic fever, in which the pulse can-
not be subdued by this remedy.   This tense state of the
pulse is the effect of a suppurative process in the liver. If
a sufficient quantity of blood has been drawn in the first
stage of this disease, there is little danger from leaving  the
pulse to reduce or wear itself down by a sudden or grad-
ual discharge of the hepatic congestion.   The recovery
in this case is .slow, but it is for the most part certain. I
have once known a dropsy  and death induced by the con-
trary practice.
  12, and lastly. There is sometimes a  tension in  the
pulse in haemorrhages, that will not yield to the lancet.
The man whose blqod was sizy, three days after loosing a
gallon and a half of it from his stomach, had a tense pulse
the day before  he  died;  and I once perceived  its  last
strokes  to be tense, in a patient whom I lost in a yellow
fever by a haemorrhage from the nose. The only circum-
stance that can justify bleeding in these cases is extreme
pain, in which case,  the loss of a few ounces of blood is
a more  safe and effectual remedy than opium.
  I  shall now add a few remarks upon the efficacy of
blood-letting, in diseases which are not supposed to belong
to the class of fevers, and which have not been included
in the preceding volumes.
  I. The philosophers, in describing the humble origin
of man, say that he is formed "inter stercus et urinam."
The divines say that he is " conceived in sin and shapen
in iniquity."  I believe it to be equally true, and alike
humiliating, that he is conceived  and  brought forth in
disease.
VOL.
ivv
E e 
218        DEFENCE OF BLOOD-LETTING.

  This disease appears in pregnancy and parturition.   I
shall first endeavour to prove this to be the case, and after-
wards mention the benefits  of blood-letting in relieving
it, in  boih cases.
   In  pregnancy,  the uterus is always affected with that
grade of morbid action which  I formerly called inflamma-
tion.   This is  evident from its exhibiting all is usual
phaenomena in other parts of the body.   These are,
   1.  Swelling, or enlargement.
   2.  Haemorrhage.  The lochia are  nothing but a slow
and spontaneous bleeding performed by nature,  and in-
tended to cure the inflammation of the uterus after partu-
rition.
  3.  Abscesses, schirri, and  cancers.  It is true, those
disorders sometimes occur in women that have never borne
children.   In these cases, they are the effects of the in-
flammation excited by the menstrual disease.
   4.  A  full, quick, and  tense or frequent pulse; pain;
want  of appetite;* sickness  at stomach; puking; syn-
cope; and sometimes convulsions in every part of  the
body.
   5.  Sizy blood.  This occurs almost uniformly in preg-
nancy.
   6.  A membrane. Dr. Scarpa has proved themembrana
decidua, which is formed during pregnancy, to be in every
respect the same in its properties with the membrane which
is formed upon other inflamed surfaces,  particularly  the
trachea, the pleura, and the inside of the bowels. Thus we
see all the common and most characteristic symptoms and
effects of inflammation,  in other  parts of the  body,  are
exhibited by the uterus in pregnancy.
   These remarks being premised, I proceed to remark,
that blood-letting is indicated, in certain states of preg-
nancy, by all the arguments  that have been used in favour
of it  in any other inflammatory disease.   The degree of
inflammation in the womb, manifested by the pulse, pain,
and other signs of disease, should determine the quantity
of blood to be drawn.  Low diet, gentle purges, and con-
  • Dr. Hunter used to teach in his lectures, that the final cause of the
want of appetite,  during the first months of pregnancy, was to obviate
plethora, which  disposes to abortion.  This plethora should have bee»
palled an inflammatory disease, in which abstinence is usefal. 
DEFENCE OF BLOOD-LETTING".
219
stant exercise, are excellent substitutes for it, but where
they are not submitted to,  blood-letting  should be  em-
ployed as a substitute for them.  In that disposition to
abortion, which occurs about the third month of pregnan-
cy, small and frequent bleedings should be preferred to all
other modes of depletion.  I can assert from experience,
that they prevent abortion, nearly with as much certainty
as they prevent a haemorrhage from the lungs: for what is
an abortion but a  haemoptysis (if  I may be allowed the
expression) from the uterus?   During the last month of
pregnancy, the loss of  from twelve to twenty ounces of
blood has the most beneficial effects, in lessening the
pains and danger of child-birth, and in preventing its
subsequent diseases.
   The doctrine I have aimed to establish leads, not only
to the use of blood-letting in  the disease of pregnancy,
when required,  but to a more copious use of it, when
combined with other diseases, than in those diseases in a
simple state. This remark applies, in a particular manner,
to those  spasms and convulsions which sometimes occur
in the latter months of pregnancy.   Without bleeding,
they are alwavs fatal.   By copious bleeding, amounting
 in  some instances to 80 and 100 ounces, they generally
 cured.
   Let it not be supposed that blood-letting is alike pro-
 per and  useful in every state  of pregnancy.—There are
 what are called  slow or chronic inflammations, in which
 the diseased action of the blood-vessels  not only forbids
 it, but  calls for cordial and stimulating remedies.  The
 same feeble state of inflammation sometimes take place in
 the pregnant uterus.  In these cases cordials and stimu-
 lants should be preferred to the lancet.
    Parturition is a higher grade of disease than that which
 takes place in pregnancy.   It consists of convulsive or
 clonic spasms in the uterus, superventing its inflammation,
 and is accompanied with chills, heat, thirst, a quick, full,
 tense, or a frequent and depressed pulse, and great pain.
 By some divines these symptoms, and particularly pain,
 have been considered  as  a standing and unchangeable
 punishment of the original disobedience of woman, and,
 by some physicians, as indispensably necessary to enable 
£20
DEFENCE OF BLOOD-LETTING.
tue uterus  to relieve itself of its burden.   By  contem-
plating the  numerous instances in  which it has pleased
God to bless the labours and ingenuity of man, in lessen-
ing or destroying the effects of the curse inflicted upon
the earth, and by attending to the histories of the total ex-
emption from pain in child-bearing that are recorded  of
the women in the Brasils,  Calabria, and some parts  of
Africa, and of the small degrees of it which  are felt by the
Turkish women, who reduce their systems by frequent
purges of sweet oil during pregnancy, I was induced to
believe pain does not accompany child-bearing by an im-
mutable  decree of Heaven.  By recollecting further how
effectually  blood-letting relieves many other spasmodic
and painful diseases, and how suddenly it relaxes rigidity
in the muscles, I was led,  in the year 1795, to suppose
it might be equally effectual in lessening the violence of
the disease and pains of parturition.  I was encouraged
still more to expect this advantage from it, by having re-
peatedly observed the advantages  of copious bleeding for
inflammatory fevers, just  before delivery,  in mitigating
its pains, and shortening its duration.  Upon  my men-
tioning these reflections and facts to Dr. Dewees, J  was
much gratified in being informed that he had been in the
practice  for several years before his removal from Abing-
don to Philadelphia, of drawing large quantities of blood
during parturition, and with all the happy effects I had ex-
pected from it. The practice has been strongly inculcated
by the doctor in his lectures upon midwifery, and has been
ably defended and supported by a  number of recent facts,
in an ingenious inaugural dissertation,  published by Dr.
Peter Miller, in the year  1804.   It has been generally
adopted by the practitioners of midwifery, of both sexes,
in Philadelphia.
   I do not mean to insinuate that bleeding is a new remedy
 in parturition.   It has long ago been advised and used in
 France,  and even by the  midwives of Genoa, in  Italy v
 but never, in any country, in the large quantities that have
 been recommended by Dr. Dewees, that is, from 20  to
 80 ounces, or until signs of fainting  are  induced, nor
 uuder the influence of the theory  of parturition, being a
 violent disease. 
           DEFENCE OF BLOOD-LETTING.        '221

  By the advantages of this remedy are not confined to
lessening the pains of delivery.  It prevents after pains;
favours the easy and healthy secretion of milk; prevents
sore breasts,  swelled legs, puerperile fever, and all the
disstressing train of anomalous complaints that often fol-
low child-bearing.   Dr.  Hunter informed his pupils, in
his lectures upon midwifery, in the year 1769, that he had
often observed the most rapid recoveries to succeed the
most severe labours.  The severity of the pains in  these
cases created a disease, which prevented internal conges-
tions m the womb.  Bleeding, by depleting the uterus,
obviates at once both disease and  congestion.  Its effica-
cy is much aided by means of glysters, which, by  emp-
tying the lower  bowels,  lessen the  pressure  upon the
uterus.
   Let it not be inferred,  from what has been said in fa-
vour of blood-letting in parturition, that it is proper in all
cases.   Where there has been great  previous  inanition,
and where there are  marks of langour, and feeble morbid
action in the system, the  remedies should be of an oppo-
site nature.    Opium and other cordials are indicated in
these cases.   Their salutary effects in exciting the action
of the uterus, and expediting delivery, are too well known
to be mentioned,
   I have expressed a hope in another place,* that a me-
dicine would be discovered that should suspend sensibili-
ty altogether, and leave irritability, or the powers of mo-
tion, unimpared, and thereby destroy labour pains alto-
gether.  I was encouraged to cherish  this hope, by having
known dilivery  to take place, in one  instance, during a
paroxysm of epilepsy, and having heard of another, dur-
ing a fit of drunkenness, in a woman attended by Dr.
Church, in doth of which there was  neither  conscious-
ness, nor recollection of pain.
   2. During the period in which the menses are said to
dodge, and for a year or two after they cease to flow, there
is a morbid  fulness  and excitement in the blood-vessels,
which are often followed by head-ach, cough, dropsy,
haemorrhages, glandular obstructions, and cancers.   They
may all be prevented by frequent and  moderate bleedings.
                 * .Medical Repository, vol. vi. 
22ii        DEFENCE OF BLOOD-LETTING.

  3. It has been  proved,  by many facts, that opium,
when taken in an excessive dose, acts by inducing a sim-
ilar state of the system with that which is induced by the
miasmata which  bring on malignant and  inflammatory
fevers. The remedy for the disease produced by it (where
a vomitting cannot be ex-cited  to discharge the opium)
has been found to  be copious blood-letting.  Of its effi-
cacy, the reader will find an account in four cases, pub-
lished in the fifth volume of the  New-York Medical Re-
pository.
  4. It is probably, from the uniformly stimulating man-
ner in  which poisons of all kinds act upon the human
body, that  bleeding would be useful in obviating their
baneful effects.  Dr.  John Dorsey has lately proved its
efficacy,  in the case of a child that was affected with con-
vulsions, in consequence of eating the  leaves of  the
datura  stramonium.
  5. It has been the misfortune of diabetes to be con-
sidered by physicians  as exclusively  a local disease of
weak morbid action, or as the effects of simple debility
in the kidneys; and hence stimulating and tonic medicines
have been exclusively prescribed for it.  This opinion is not
a correct one.   It often affects the whole arterial system,
more especially in  its first stage, with great morbid action.
In two cases of it, where  this state of the  blood-vessels
took place, I have used blood-letting with  success, join-
ed w7ith the common remedies for inflammatory diseases.
  6. In intermitting fevers which have long resisted the
use of bark, and  all the common stimulating and tonic
remedies which are employed to cure them, bleeding is
generally a certain remedy.   Many hundred instances of
its efficacy in  such cases could be mentioned from the re-
cords of the practice in the Pennsylvania hospital, as well
as from the private practice of many of the physicians of
Philadelphia.
  7. In dislocated bones which resist both skill and force,
it has been suggested, that  bleeding,  till fainting is in-
duced,  would  probably induce  such a relaxation in the
muscles as to favour their reduction.   This principle was
happily applied, in the winter of 1795, by  Dr.  Physick, 
            BEFENCE OF BLOOD-LETTING.        223

 in the Pennsylvania hospital, in a case of dislocated hu-
 merus of two months continuance.  The doctor bled his
 patient till he fainted, and then reduced his shoulder in
 less than a minute, and with very little exertion of force.
 The practice has since become general in Philadelphia,
 in luxations of large bones, where they resist the common
 dregrees of strength imployed to reduce them.
   In contemplating the prejudices against  blood-letting,
 which formerly prevailed so generally in our country, I
 have been led  to ascribe them to a cause wholly political.
 We are descended chiefly from Great-Britain, and have
 been for many  years under the influence of English  habits
 upon all subjects.   Some of these habits, as far as they
 relate to government, have been partly changed; but in
 dress, arts, manufactures, manners, and  science, we are
 still governed by our early associations.  Britain and France
 have been, for many centuries, hereditary enemies.   The
 hostility of the former t!b the latter nation, extends to every
 thing that belongs to their character.   It discovers itself,
 in an eminent degree, in diet and medicine. Do the French
 love soups? the English prefer solid flesh.  Do the French
 love their meats well cooked? the English  prefer their
 meats but half roasted.   Do the  French sip coffee after
' dinner? the English spend their  afternoons in drinking
 Port and Madeira wines.   Do the French physicians pre-
 scribe  purges and glysters to  cleanse the bowels?  the
 English physicians prescribe vomits for the same purpose.
 Above  all, do the French  physicians advise  bleeding in
 fevers?  the English physicians forbid it in most fevers,
 and substitute sweating in the room of it.   Here then wc
 discover the source  of the former prejudices and  errors
 of our  countrymen,  upon the  subject of blood-letting.
 They are of British  origin.  They have been inculcated
 in British universities, and  in British  books; and they
 accord as ill with our climate and state of society,  as the
 Dutch foot stoves did with the temperate  climate  of the
 Cape of Good Hope.
   It is probable the bad consequences which have follow-
 ed  the indiscriminate  use  of the lancet  in France, and
 some other countries,  may have contributed  in some de-
 gree to create the prejudices against it, which are entertain. 
224        DEFENCE OF BLOOD-LETTINc'.
ed by the physicians in Great-Britain.  Bleeding, like
opium, has lost its character in many cases, by being pre-
scribed for the name of a disease.   It is still used, Mr.
Townsend tells us, in this empirical way in Spain, where
a physician, when sent for to a patient, orders him to be
bled before he visits him.   The late just theory of the
manner in which opium acts upon the body, has restrained
its mischief, and added greatly to its usefulness.   In like
manner, may we not hope, that just theories of diseases,
and proper ideas of the manner in which bleeding acts in
curing them, will prevent a relapse into the evils which
formerly accompanied this  remedy, and render it a great
and universal blessing to mankind?
0 
             AN INQUIRY





                 INTO THE





COMPARATIVE STATE OF MEDICINE,





            IN PHILADELPHIA,





                 BETWEEN





     THE YEARS 1760 AND 1766, AND THE YE>R 18Cp.
VOL. IV,            Ff 
/
?X*hi 
AN INQUIRY,  &c.
     IN estimating the progress and utility of medicine,
important advantages may be derived from taking a view
of its ancient, and comparing it with its present state.  To
do this upon an extensive scale, would be difficult, and
foreign to the design of this inquiry.  I  shall therefore
limit it,  to the history of the diseases and medical opi-
nions which prevailed,  and of the remedies which were in
use,  in the city of Philadelphia, between the years 1760
and 1766, and of the diseases, medical opinions, and re-
medies of the year 1809.  The result of  a  comparative
view of each of them,  will determine whether medicine
has declined or improved, in that interval of time, in this
part of the world.
  To derive  all the benefits that are possible from such
an inquiry, it will be proper  to detail the causes,  which,
by acting upon the human body, influence the subjects
that have been mentioned, in those two remote periods of
time.
  Those causes divide themselves into  climate, diet,
dress, and certain peculiar customs; on each of which I
shall make a few remarks.
  After what has been said, in the history of the Climate
of Pennsylvania, in the second volume of these  Inquiries,
it will only be necessary in this place briefly to mention,
that the winters in Philadelphia, between the years 1760
and 1766, were almost  uniformly cold. The ground was
generally covered with snow, and the Delaware frozen,
from the  first or second week in December, to the last
week in February, or the first week in March.  Thaws
were rare during the winter months, and seldom of longer
duration than three or four days.  The springs began in
May.  The summers were generally warm, and the air 
223            STATE OF MEDICINE^
seldom refreshed by cool north-west winds.  Rains w ere
frequent and heavy, and for the most part accompanied
with thunder and lightning.  The autumns began in Oc-
tober, and were  gradually  succeeded by  cool and  cold
weather.
   The diet of the inhabitants of Philadelphia,  during
those years,  consisted chiefly of animal food. It was eaten,
in some families, three times, and in all, twice a day.  A
hot supper was a general meal. To two and three meals
of animal food in a day, many persons added what was
then called  *<a relish," about an hour before dinner.  It
consisted of a slice of ham;  a piece of salted fish, and
now and then  a beef-steak,  accompanied with large
draughts of punch or toddy.  Tea was taken in  the in-
terval between dinner and supper.
   In many  companies, a glass of wine and  bitters was
taken a few minutes before dinner, in order to increase
the appetite.
   The  drinks, with dinner and supper, were punch and
table beer.
   Besides feeding thus plentifully in their families, many
of the most respectable citizens belonged  to clubs, which
met in the city in winter, and in its vicinity, under sheds,
or the shades of trees, in summer, once and twice a week,
and in one instance every night.   They were drawn to-
gether by  suppers in  winter, and dinners" in summer.
Their food was simple, and taken chiefly  in a solid form.
The liquors used with it were punch, London porter and
sound old Madeira wine.
   Independently of these clubs, there were occasional
meetings of citizens, particularly of young  men, at  taverns,
for convivial purposes. A house  in Water-street, known
by the name of the Tun tavern,  was devoted chiefly to
this kind of accidental meetings.  They were often fol-
lowed by midnight sallies  into the streets, and such acts
of violence and indecency, as frequently consigned the
perpetrators of them afterwards into the hands of the ci-
vil officers and physicians of the city.
   Many citizens, particularly tradesmen, met every even-
ing for the  purpose of drinking beer, at houses kept  for
 that purpose. Instances of drunkenness were rare at such
 places.  The company generally  parted  at ten o'clock^ 
        BETWEEN 1760 AND 1766, AND 1809.   229

and retired in an orderly manner to their habitations-
Morning drams, consisting of cordials of different kinds,
were common, both in taverns and  private houses, bnt
they were confined chiefly to the lower class of people.
  From this general use of distilled and fermented liquors,
drunkenness was a common vice in all the different ranks
of society.
  The dresses of the men, in the years alluded to, were
composed of cloth in winter, and of thin woollen or silk
stuffs in summer.  Wigs composed the covering of the
head, after middle life, and cocked hats were universally
worn, except by the  men who belonged to the society of
Friends.
  The dresses of the women, in  the years before men-
tioned,  consisted  chiefly of silks and callicoes.  Stays
were universal, and hoops were generally worn by the la-
dies in genteel life.  Long cloth or camblet cloaks were
common, in cold weather, among all classes of women.
  The  principal custom under  this head,  which influ-
enced health and life, was that which obliged women, af-
ter lying in, "to sit  up for company;" that is to dress
themselves, every  afternoon on  the  second week after
confinement, and to sit for four or five hours, exposed to
the impure  air of a  crowded room, and sometimes to
long and loud conversations.
  Porches were nearly universal appendages tohouses, and
it was common for all the branches of a family to expose
themselves upon them, to the evening air.  Stoves were
not in use at that time, in any places of public worship.
   Funerals were attended by a large concourse of citizens,
who were thereby often exposed to great  heat and cold,
and sometimes to standing, while the funeral obsequies
were performed, in a wet or damp church-yard.
   The human mind, in this period of the history of olir
city, was in a colonized state, and the passions acted but
feebly and partially upon literary and political subjects.
  We come now to  mention the diseases which prevail-
ed in our city between the years  1760 and  1766.
   The  cholera morbus was a frequent disease in the sum-
mer months.
   Sporadic cases of dysentery were at that time com-
 mon.  I have never seen that disease epidemic in Phila-
 delphia. 
2*0
STATE OF MEDICINE,
   The intermitting fever prevailed in the month of Au-
gust, and in the autumn, chiefly in the suburbs and neigh-
bourhood of the city.   In the year 1765, it was epidemic
in Southwark, and was so general, at the same time, as
to affect two thirds  of the  inhabitants  of the southern
states.   This fact is mentioned by Dr Bond, in a lecture
preserved in the minutes of the managers of the Penn-
sylvania hospital.
   The slow chronic fever, called at that time the nervous
fever, was very common, in the autumnal months, in the
thickly settled parts  of the city.
   The bilious fever prevailed, at the same time, in South-
wark.  The late  Dr.  Clarkson,  who began to practice
medicine in that part of the city, in the year 1761, upon
hearing some of his medical  brethren  speak of the ap-
pearance of bilious remittents in its middle and northern
parts, about the year  1778, said they had long been fa-
miliar to him,  and that he had met with them every year
since his settlement in Philadelphia. *
   The yellow  fever prevailed in  the neighbourhood of
Spruce-street  wharf, and near  a filthy stream of water
which flowed through  what is now  called Dock-street,
in the year 1762.  Some cases of it  appeared likewise
in Southwark.   It was scarcely known in the north and
west  parts of the city.   No desertion of the citizens took
place at this time, nor  did the  fear of contagion drive the
friends of the sick from their bed-sides, nor prevent the
nsual  marks of respect being paid to them after  death,
by following their bodies to the grave.  A few sporadic
cases of the  same grade of fever appeared in the year
1763'.
   Pncumonics, rheumatisms, inflammatory  sore throats,
and catarrhs were frequent during the winter and  spring
months.  The last disease was induced, not only by sud-
den changes in the weather, but often by exposure to the
  * I'mrn the early knowledge this excellent  physician and worthy man
If.'id thus  sicquiv-d of the billions remitting fever, he was very successful in
ihe treatment of' it.   It was by instruction conveyed by him to me with pecu-
liar delicacy,- tl.at l was first taught the advantages of copious evacuations
from the bowels in that disease  I had been called, when a young practitioner,
to visit a gentleman  with him in a billions pleurisy. A third or fourth bleeding,
which  1 advised cured him.  The doctor was much pleased with its effect,
and said to me afterwards, " Doctor, you and I have each a great &ult in our
pia'tice ; 1 do not bleed enough, you do not purge enough." 
        BETWEEN 1760 AND 1766, AND 1809.     -iJl

evening air on porches in summer, and by the damp and
cold air of places of public worship in winter.
  The influenza was epidemic in the city in the spring
of the year 1761.
  The malignant sore throat proved fatal to a number of
children in the winter of 1763.
  The scarlet fever prevailed generally in the year 1764.
It resembled the same disease, as described by Dr. Syden-
ham, in not being accompanied by a sore throat.
  Death from convulsions, in pregnant women, also from
parturition, and the puerperile fever, were common be-
tween the years 1760 and 1766. Death was likewise com-
mon between the 50th and 60th years of life from gout,
apoplexy, palsy, obstructed livers, and dropsies.  A clufy
consisting of about a dozen of the first gentlemen in the
city, all paid, for their  intemperance, the forfeit of their
lives between those  ages, and most of them with some
one, or more of the diseases that have been mentioned. I
sat up with one of that club on the night of his death. Se-
veral of the members of it called at his house, the evening
before he died, to inquire how he was. One of them up-
on being informed of his extreme danger, spoke in high
and pathetic terms of his convivial talents and virtues, and
said, " he had spent 200 evenings a year with him, for
the  last twenty years of his  life."  These evenings were
all spent at public houses.
   The colica pictonum, or dry gripes, was formerly a com-
mon disease in this city.  It was sometimes followed by
a palsy of the upper and lower extremities.   Colics from
crapulas were likewise very frequent, and now  and then
terminated in death.
   Many children died ef the cholera infantum, cynanche
trachealis, and hidrocephalus intcrnus.  The last disease
was generally ascribed to worms.
   Fifteen or twenty deaths occurred,  i^very summer, from
drinking cold pump water, when the body was in a highly
 excitable state, from great heat and  labour.
   The small pox, within the period alluded to, was some
 times epidemic, and carried off many citizens.  In the
year 1759, Dr. Barnet was invited from Elizabeth-town,
 in New-Jersey, to Philadelphia, to inoculate for the small- 
232             STATE OF MEDICINE.

pox.   The practice, though much opposed, soon became
general.  About that time, Dr. Redman published a short
defence of it, and recommended the practice to his fellow-
citizens in the most affectionate language.   The success
e^f inoculation was far from being universal.  Subsequent
improvements in the mode of preparing the  body,  and
treating the eruptive fever, have led us to ascribe this want
of suocess to the deep wound made in the arm, to the ex-
cessive quantity of mercury given to prepare  the  body,
and to the use of a warm regimen in the eruptive fever.
  The peculiar customs and the diseases which have been
enumerated, by inducing general weakness, rendered the
pulmonary consumption a frequent disease among both
sexes.
  Pains and diseases from decayed teeth where very com-
mon between the years 1760  and  1766.    At  that time,
the profession of a dentist was unknown in the city.
  The practice of physic and surgery were united, dur-
ing th .:■/- years, in  the same persons, and physicians were
seldom imployed as man-midwives, except in preterna-
tural and tedious labours.
  The practice of surgery was regulated by Mr. Sharp's
treatise upon that branch of medicine.
  Let us now take a view of the medical opinions which
prevailed at the above period, and of the remedies which
were employed to cure the diseases that have been men-
tioned.
  The svstem of Dr. Boerhaave then governed the prac-
:r    every physician in Philadelphia. Of course diseases
were ascribed to morbid acrimonies, and other matters in
the blood, and the practice of those years was influenced
by a belief in them.  Medicines were prescribed to thin,
and to incrassate the blood, and diet drinks were admi-
nistered in great quantities, in order to alter its qualities.
Great reliance was placed upon  the  powers of nature,
and critical days were expected  with solicitude, in or-
der to observe the  discharge  of the morbid cause of fe-.
vers  from the system.  This matter was looked for chiefly
in the urine, and glasses to retain it were a necessary part
of the furniture of every sick room.  To ensure the dis-
charge of the supposed morbid  matter of fevers through 
        BETWEEN 1760 AND 1766, AND 1809.    233

the pores, patients were confined to their bed-, and fresh,
and even cool air,  often excluded  by close  doors and
curtains.  The  medicines to promote sweats were  ge-
nerally  of a feeble nature.  The spiritus mindereri, and
the spirit of sweet nitre  were in daily use for that pur-
pose.   In dangerous cases,  saffron  and Virginia snake-
root were added to them.
   Blood-letting was used plentifully in pleurisies and rheu-
matisms, but sparingly in all odier diseases,   biood was
often drawn from the feet, in order to excite a revision
of disease from the superior pars of the body.    It was
considered as unsafe,  at tnat tinv ,  10 bleed during the
monthly disease of the female sex.
   Purges or vomits began the cure of all febrile diseases,
but as the principal dependence was placed upon  sweat-
ing medicines, those powerful  remedies were seldom  re-
peated  in the subsequent stages of fevers. To this remark
there was a general exception in the yellow fever of 1762.
Small doses of glauber's salts were given every day after
bleeding, so as to promote a gentle, but constant discharge
from the bovvels.
   The bark was administered freely in intermittents. The
prejudices against it at that time were so general among
the  common people,  that it was often necessary to dis-
guise it.   An opinion prevailed among them, that it lay
in their bones,  and that it disposed them to take cold.
It was seldom given in the low and  gangrenous states of
fever, when they were not attended with  remissions.
   The use of opium was  confined chiefls  to ease pain,
 to compose a cough,  and to restrain preternatural dis-
 charges from the body.   h>uch were  the prejudices against
 it, that it was often necessary to conceal it in other me-
 dicines.  It was rarely taken  without the advice of a phy-
 sician.
   Mercury was in general use in the years that have been
 mentioned.   I have said it was given to prepare the body
 for the small-pox.   It was administered by my first pre-
 ceptor in medicine, Dr. Redman,  in the same disease,
 when it appeared in the natural way,  with  malignant or
 inflammatory  symptoms, in order  to keep  the  salivary
 glands open  and flowing, during the turn of the pock.
    vol.  IV.               g g 
234
STATE OF MEDICINE,
He gave it likewise liberally in the dry gripes.   In one
case of that disease, I well remember the pleasure he ex-
pressed, in consequence of its having affected his patient's
mouth.
  But to Dr. Thomas Bond the city of Philadelphia is
indebted for the introduction of mercury into general use,
in the practice of medicine.   He called it emphatically
61 a revolutionary remedy," and prescribed it  in  all dis-
eases which resisted the common modes of practice. He
gave it liberally in the cynanche trachealis.  He sometimes
cured madness, by giving it in such quantities as to excite
a salivation.  He attempted to cure pulmonary consump-
tion by it, but without success ; for, at that time, the in-
fluence of  the relative actions of different diseases and
remedies, upon the human body,  was not  known, or.  if
known, no advantage was  derived from it in the practice
of medicine.
  The dry gripes were cured,  at that time, by a new and
peculiar mode of practice, by Dr. Thomas Cadwallader.
He kept the patient easy by gentle  anodynes, and gave
lenient purges only in the  beginning of the disease; nor
did he ever assist the latter by injections till  the fourth
and fifth days, at which time the bowels discharged their
contents in an easy manner.   It was said this mode of
cure prevented the paralytic symptoms, which sometimes
follow that disease. It was afterwards adopted  and highly
commended by the late Dr. Warren, of London.
  Blisters were in  general use,  but seldom applied before
the latter stage of fevers.  They were prescribed, for the
first time,  in  haemorrhages,  and with great success, by
Dr. George Glentworth.   -
  \V ine was  given sparingly, even in the lowest stage of
what were then called putrid and nervous fevers.
  The warm and  cold baths were but little used in pri-
vate practice.   The former was now and then employed
in acute  diseases.   Thev were both  used in the  most
liberal manner, together with the vapour and  warm air
baths, in the Pennsylvania hospital, by Dr. Thomas Bond.
An attempt was made to erect warm and cold baths, in
the neighbourhood of the city, and to connect them with
a house of entertainment,  by Dr. Lauchlin M'Clen, in
the year 1761.  The project was considered as unfriendly 
       BETWEEN 1760 AND 1766, AND 1809.    23."

to morals, and petitions, from several religious societies,
were addressed to the governor of the  province, to pre-
vent its execution.  The enterprize was abandoned, and
the doctor soon afterwards left the city.
   Riding on horseback, the fresh air of the seashore, ex-
cursions'to mineral springs, and longjournies, were often
prescribed to invalids,  by all the physicians of  that day.
   I come now to mention the causes which  influence the
diseases, also the medical opinions and remedies of the
present time.   In this  part of our discourse, I shall fol-
low the order of the first part of our inquiry.
   I have already taken notice of the changes  which the
climate of  Philadelphia  has undergone  since  the year
1766.
   A change has  of late years taken place in the dress of
the inhabitants of Philadelphia.   Wigs  have generally
been laid aside, and the hair worn cut and dressed in dif-
ferent ways.   Round  hats, with high  crowns, have be-
come  fashionable. Umbrellas, which were formerly a
part of female dress  only, are now used in warm and
wet weather,  by men  of all ranks in society; and flannel
is worn  next to the skin in the winter, and muslin in sum-
mer,  by manv persons of  both sexes.   Tight dresses
are uncommon,  and stays are unknown  among our wo-
men.  It is to be lamented that the  benefits  to  health
which might have been derived from the disuse of that
 part of female dress, have been prevented by the fashion
 of wearing such light coverings over the breasts and
 limbs.  The evils from this cause, shall be  mentioned
 hereafter.
    A revolution  has taken  place in the  diet of our citi-
 zens.  Relishes  and suppers are generally abolished; bit-
 ters, to provoke a preternatual appetite,  also  meridian
 bovls of punch, are now scarcely known.   Animal lood
 is eaten onlv  at  dinner, and excess in the use ot it is
 prevented,  by a profusion of excellent summer and winter
 vegetables.                               .
    Malt liquors,  or hvdrant water, with a moderate quan-
 tity of wine,  are usually  taken with those  simple and
 wholesome meals. 
236
STATE OF MEDICINE,
  Clubs,  for the exclusive purpose of feeding, are dis-
solved, and succeeded by family parties, collected  for the
more rational entertainments of conversation, dancing,
music, and chess.   Taverns and beer houses are much
less frequented than formerly, and drunkenness is rarely
seen in genteel life.   The  tea table,  in  an evening,  has
now become the place of resort of both sexes, and the
midnight  serenade has taken place of the midnight revels
of the young gentlemen  of former, years.
   In doing justice to die temperance of the modern citi-
zens of Philadelphia, 1 am  sorry to admit, there is  still
a good deal of secret drinking among them.  Physicians,
who  detect it by  the diseases it produces, often  lament
the inefficacy of their remedies to remove  them. In addi-
tion to intemperance from spirituous liquors, a new spe-
cies of intoxication  from opium has found its way into
our city.   I have  known death,  in one instance, induced
by it.
   The following circumstances have had a favourable in-
fluence upon the health of the present inhabitants of Phi-
ladelphia.
   The improvements  in  the construction  of modern
houses, so as to  render them  cooler  in  summer,  and
warmer in winter.
   The less frequent practice of sitting on porches, expos-
ed to the  dew, in summer  evenings.
   The universal  use of stoves  in places  of  public wor-
ship.
   The abolition of the custom  of obliging lying-in wo-
men  to sit up for  company.
   The partial use of Schuylkill  or hydrant water, for
culinary and other purposes.
   The enjoyment of  pure air,  in country seats, in the
neighbourhood of the city.   They not  only preserve
from sickness during the summer and autumn, but  they
render families less liable to diseases  during the other
seasons of the year.
   And,  lastly, the frequent use of private, and public
warm and cold baths.   For the  establishment of  the lat-
ter, the citizens of Philadelphia are indebted to Mr. Jo-
seph Simons. , 
       BETWEEN 1760 AND 1766, AND 1809.     237

  The following circumstances have an unfavourable in-
fluence upon the health of our citizens.
  Ice creams taken in excess, or upon an empty stomach.
  The continuance of the practice of attending funerals,
under all the circumstances that were mentioned in de-
scribing the  customs which prevailed  in Philadelphia,
between the years 1760 and 1766.
  The combined  influence of great heat  and intempe-
rance in drinking, acting upon passions unusually excited
by pu die objects, on the 4th of July every year.
  The general and inordinate use of segars.
  The  want  of sufficient  force in the water which falls
into the  common sewers  to convey their contents into
the Delaware,  renders each of their apertures a source
of sickly  exhalations to  the neighbouring  streets  and
squares.
   The  compact manner  in which the  gutters  are now
formed,  by  preventing the descent  of water into the
earth, has contributed very much to retain the filth of the
eity, in those  seasons in  which they are not washed by
rain, nor by the waste water of the pumps and hydrants.
   The timbers of many of  the wharves of the city have
 gone to decay.  The docks have not been cleaned since
 the year 1774, and many of them expose' large surfaces
 to the action of the  sun at low  water.  The buildings
 have increased in Water-street, and with them there has
 been a great increase of that kind of filth which is gen-
 erated in all houses; the stores in this street  often contain
 matters which putrefy ; from all  which there is,  in warm
 weather, a constant emission of such a fcctid odour, as to
 render a walk through  that street, by a person who does
 not reside there, extremely disagreeable, and sometimes
 to produce sickness and vomiting.
   In many parts of the vicinity of the city are to be seen
 pools of stagnating water, from which there are exhaled
 large quantities of unhealthy vapours, during the summer
 and autumnal months.
   The privies have become so numerous,  and are often
 so  full, as to become offensive  in most of the compact
  parts of the city, more especially in damp weather.
    The pump water is impregnated with many saline and
  erial matters of an offensive nature. 
238
STATE Of MEDICINE,
   While these causes exert an unfriendly influence upon
the bodies of the citizens of Philadelphia,  the extreme
elevation or-depression of their passions, by the different
issues of their political contests,  now far surpassing, in
th .ir magnitude, the contests of former years, together with
their many new and fortuitous modes of suddenly acquir-
ing and losing property, predispose them to many diseases
of the  mind.
   The present diseases of Philadelphia come next under
our  consideration.
   Fevers have assumed several new forms since the year
1766.   The mild billions fever has gradually spread over
every  part of the city.  It followed the filth which was left
by the British army in the year 1773.  In the year 1780,
it prevailed, as an epidemic, in Southwark, and in Water
and  Front-streets,  below Market-street.*   In the years
1791 and 1792, it assumed an inflammatory appearance,
and  was  accompanied, in many cases, with hepatic affec-
tions.  The connection of our subject requires that I should
barely repeat, that it appeared in 1793 as an epidemic, in
the form of what is  called yellow fever, in which fcrm it
has appeared, in sporadic cases, or as an epidemic, nearly
every year since.   During the reign of this high grade of
bilious fever, mild intermittents and  remittents, and the
chronic or nervous  forms of the summer and autumnal
fever,  have nearly disappeared.
   Inflammations and obstructions of the liver have been
more frequent than in former years, and even the pneumo-
nies, catarrhs, intercurrent, and other fevers of the winter
and  spring months, have all partaken more  or less of the
inflammatory and malignant nature of the yellow fever.
   Thepuhnonary consumption continues to be a common
disease among both sexes.   Women are more subject to
it than:ncii, i;, consequence of their light dresses, and par-
ticularly of tiie exposure of  their upper arms (a part of the
body with which the lungs  sympathise in a peculiar man-

  * It appears, from the account given by Mr. White of the billions fever of
Ba' n,  tliat  it prevailed several  years  in  its  suburbs,  before it became
general  in that city.   It  is remarkable, that Southwark  was nearly the
exclusive seat, not only of the bilious  or breakbone fever of 1780,  but of
the intermitting fever in 1765, taken notice of by Dr. Bond, and of tue yellow
fever of lfiijj. 
        BETWEEN  1760 AND 1766, AND 1809.    239

ner) to the cold air.  The frequency  of consumptions
from  this cause, has given rise to a  saying that " the
nakedness of the women,  is the clothing of the physi-
cians."
  The cynanche trachealis, the scarlatina anginosa, the
hydrocephalus  internus, and cholera infantum, are like-
wise common diseases in Philadelphia.
  Madness, and several other diseases of the  mind, have
increased since the year 1766, from causes  which have
been  mentioned.
  Several of the different forms of gout are still common
among both sexes.
  Apoplexy and palsy  have considerably diminished in
our city.   It is true, the bills of mortality still record a
number of deaths from the former, every year; but this
statement is  incorrect, if it mean a disease  of the brain
only, for sudden deaths from all their causes are returned
exclusively  under the name of apoplexy^  The less fre-
quent occurrence of this disease, also of  palsy, is proba-
bly occasioned by the less  consumption  of animal food,
and of distilled and  fermented liquours,  by that class of
citizens who are most subject to them,  than in  former
years.  Perhaps  the round hat,  and the general use of
umbrellas, may have contributed to lessen those diseases
of the brain.
   The dropsy  is now a rare disease, and seldom seen
even  in our hospital.
   Thecolica pictonum, or dry gripes,  is scarcely known
in  Philadelphia.  I have ascribed this to the use of flan-
nel next to the skin as a part of dress,  and to the general
disuse of punch as  a common drink.
   The natural small-pox  is nearly  extirpated,  and the
puerperile fever is rarely met with in Philadelphia.  The
scrophula is much  less frequent than in for.ner ye.ars.  It
is confined chiefly to persons in humble life.
   I proceed, in the order that was proposed, to take notice
of the present medical opinions which prevail among the
physicians of Philadelphia. The system of Dr. Boerhaave
long ago ceased  to regulate  the practice of  physic.  It
was succeeded by the system of Dr. Cullen.  In the year
 1790, Dr.  Brown's system of medicine  was introduced 
240            STATE OF MEDICINE,
and taught by Dr. Gibbon.   It captivated a few young
men for a while, but it soon  fell into disrepute.  Perhaps
the high-toned diseases of our city exposed the  fallacy
and danger of the remedies inculcated by.it, and afforded
it a shorter life than it has had  in  many other countries.
In the year 1790, the author of this inquiry promulgated
some new principles in medicine suggested by the peculiar
phenomena of the diseases of the United States.  These
principles have been  so much enlarged and improved by
the successive observations and reasonings of many gen-
tlemen in all the states, as to form a new system of me-
dicine.   This system rejects the nosological arrangement
ot diseases, and admits only of a single disease, consisting
in different forms of morbid  excitement, induced by irri-
tants acting upon  previous  debility.   It rejects further,
an. undue reliance upon the powers of nature, and teaches,
instantly to wrest the cure of all violent and feeble diseases
out of her hands;  and lastly it rejects prescriptions for
the names of diseases;  and by directing their application
wholly to their forming and fluctuating  states, derives
from a few active medicines all the advantages which have
been in vain expected from  the numerous articles which
compose  European  treatises upon the materia medica.
This system has been adopted by a part of the physicians
of Philadelphia,  but  a  respectable number  of them are
still attached to the system of Dr. Cullen.
   A great change  has taken place in the remedies which
are now in common  use in Philadelphia.   I shall briefly
mention such of them  as are new, and then take notice
of the new and different modes of exhibiting such as were
in use between the years 1760 and 1766.
   Vaccination has been  generally adopted in our city, in
preference to inoculation with variolous matter.
   Digitalis, lead, zinc, and arsenic are now common re-
medies in the hands  of most of our practitioners.
   Cold air, cold water, and  ice are among the new reme-
dies of modern practice in Philadelphia.
   Blood-letting is now used in nearly all diseases of vio-
lent excitement,  not only in the blood-vessels,  but in
other parts of the body.   Its  use is not, as in former times;
limited to ounces  in specific diseases, but regulated by 
        BETWEEN  1760 AND 1766, AND 1809.    241

their force, and the importance  of the parts affected to
health and life; nor is it forbidden, as formerly, in infancy
nor in extreme old  age, nor in the summer  months, nor
in those cases in which the blood is dissolved, or devoid
of an  inflammatory  crust, provided the pulse be full or
tense, nor in the period of menstruation, where symptoms
of a violent, or of a suffocated disease,  manifested by an
active or feeble pulse, indicate it to be necessary.
   Leeches are now in general use in diseases which are
removed, by their seat or local nature, beyond the influ-
ence of the lancet.   For the introduction of this excel-
lent remedy into our city we are indebted to Mr.  John
Cunitz.
   Opium and bark,  which were formerly given in dis-
guise, or with a trembling hand, are now, not only pre-
scribed  by physicians, but often purchased, and  taken
without their advice, by many of the citizens of Philadel-
phia.   They even occupy a shelf in the closets of  many
families.
   The use of mercury has been revived, and a salivation
has been extended, with great improvements  and success,
to nearly all violent and obstinate diseases.   Nor has the
influence of reason over ignorance and prejudice, with re-
spect  to that  noble medicine, stopped here.   Cold water,
once supposed to be incompatible with its  use, is now
applied  to the body, in  malignant fevers, in  order to in-
sure and accelerate its operation  upon the salivary glands.
But this is not all.   It is applied locally, and universally
to restrain, or to check a salivation, when it exceeds in its
degree or  duration, the exigencies of a disease, or the
wishes of a physician.
   Wine is given in large quantities, when indicated,
without the least fear of producing intoxication.
   The warm and cold baths, which were formerly con-
fined  chiefly  to patients in the Pennsylvania hospital, are
now common prescriptions in private practice.
   Exercise,  country air, mineral springs,  and the sea
shore, are now universally recommended in  chronic dis-
eases, and in the debility which precedes  and follows
rhem.
   vol.  iv.               ii h 
242
STATE OF MEDICINE,'
  Great pains are now taken to regulate the quantity and
quality of aliments and drinks, by the peculiar state of the
system.
  Let us now inquire into the influence of the new opin-
ions in medicine, and the new remedies which have been
mentioned, upon human life.
  The small-pox, once the most fatal and universal of all
diseases, has nearly ceased to occupy a place in our bills
of mortality, by the  introduction  of  vaccination in our
city.  For  the  prompt adoption of this great discovery,
the citizens of Philadelphia owe a large debt of gratitude
to Dr. Coxe, and Mr. John Vaughan.
  Fevers, from all their causes, and in all their forms, with
the exception of the bilious yellow fever, now yield to me-
dicine. Even that most malignant form of febrile diseases
is treated with more success in Philadelphia than in other
countries.  It would probably seldom prove mortal, did
a belief in its being derived from an impure atmosphere,
and of its exclusive influence upon the body, while it
prevailed as an  epidemic, obtain universally among the
physicians  and  citizens of Philadelphia.
  The pulmonary consumption has been  prevented, in
many hundred instances, by meeting its premonitory signs,
in weakness and feeble morbid excitement in  the whole
system, by country air,  gentle exercise, and gently stim-
ulating remedies. Even when formed, and tending rapid-
ly to its last stage, it has been cured by small and frequent
bleedings,  digitalis, and a mercurial salivation.
   The hydrocephalus intcrnus, the cynanche  trachealis,
and cholera infantum, once so fatal to the children of our
city, now yield to medicine in the early stages.   The two
form erare cured by copious bleeding, aided by remedies
formerly employed in them  without success.   The last
is cured by moderate bleeding, calomel, laudanum, and
country air.
   The gout has been torn from its ancient sanctuary in
error  and prejudice, and its acute paroxysms  now yield
with as much certainty to the lancet, as the most simple
inflammatory diseases.
   The dropsy  is cured  by  renouncing the unfortunate
association of specific remedies with its name, and accom- 
        BETWEEN 1760 AND 1766, AND 1809.    243

modating them to the degrees of excitement in the blood-
vessels.
  The  tetanus from wounds is now prevented, in most
cases, by inflaming the injured parts, and thereby com-
pelling them to defend the whole system,  by a local dis-
ease.   Where this preventing remedy has been neglected,
and where tetanus arises from other causes than wounds,
it has often been cured by adding to the diffusible stimu-    *
his of opium, the durable stimuli of bark and wine.
  Death from drinking cold water, in the heated state of
the body, is now obviated by previously wetting the hands
or feet with the water; and  when this precaution is neg-
lected,  the  disease induced by it, is generally cured by
large doses of liquid laudanum.
  Madness, which formerly doomed its miserable subjects
to cells or chains for life, has yielded to bleeding, low diet,
mercury, the warm and cold baths, fresh air, gentle exer-
cise, and mild treatment, since its seat has been discovered
to be in the  blood-vessels of the brain.
   The  last achievement of our science in Philadelphia,
that I shall mention, consists in the discovery and observa-
tion of the  premonitory signs of violent and mortal dis-
eases, and in subduing them by simple remedies, in their
forming state.   By this means,  death has been despoiled
of his prey, in many hundred instances.
   In this successful conflict of medicine with disease and
death, midwifery and surgery have borne a distinguished
part.   They derive their claims to  the gratitude of the
citizens of Philadelphia from the practice of each of them
being more confined, than formerly, to a few members of
 our profession.  It is in consequence of the former being
 exercised only by physicians of regular and extensive edu-
 cation, that death from pregnancy and parturition is a rare
 occurrence in Philadelphia.   For the discovery and intro-
 duction of the means  of preventing it from the latter dis-
 ease by copious blood-letting, also for the discovery of the
 partial inversion of the uterus, and the method of reducing
 it,  the citizens of Philadelphia are indebted to Dr. De-
 wees.
   I should greatly exceed the limits prescribed to this in-
 quiry, should I mention how much pain and misery have
 been relieved, and how often death has been baffled in his 
244            STATE OF MEDICINE,
  attempts upon human life, by several late improvements
  in oid, and the discovery of new remedies in surgery.  I
  shall briefly name a few of them.
     In cases of blindness, from a partial opacity of the cor-
  nea, or from a closure of the natural pupil, a new pupil
  has been made; and where the cornea has been partially
• opaque,  the  opening through the iris has been formed,
  opposite to any part of it, which retain its transparency.
     The cure of fractures has been accelerated by  blood-
  letting,  and, where the union of a broken bone has not
  taken place from a defect of bony matter, it has been pro-
  duced by passing a seton between the fractured ends of
  the bone, and effecting a union  thereby between them.
  Luxations,  which have long resisted both force and art,
  have been reduced in a few  minutes, and without pain,
  by bleeding at diliquium animi.
     Old sores have been speedily healed, by  destroying
  their surfaces, and thereby placing them in the condition
  of recent accidents.
     Erysipelas is cured, and external mortifications are
  checked, by the application  of blisters to the parts af-
  fected.
     The fruitless application of the trepan, in concussions
  in the brain, has been prevented by copious bleeding and
  a salivation.
     A suppression of urine has been cured, by the addition
  of a piece of a bougie, to a flexible catheter.
     Strictures  in the urethra have been removed by means
  of a caustic, also, in a more expeditious way, by dividing
  them with a lancet.
     Hydrocele has been  cured by a  small puncture, and
  afterwards  exciting inflammation and adhesion by  an in-
  jection of wine into the tunica vaginalis testis.
     The popliteal aneurism and varicose veins have both
  been removed by operations  that were unknown a few
  years ago.
     For the introduction of several of those new surgical
  remedies, and for the discovery and improvement of others,
  the citizens of Philadelphia are indebted to Dr. Physick.
  They are likewise indebted to him and Dr. Griffitts for
  manyofthfc new and successfulmodes of practice, in the 
BETWEEN  1760 AND 1766, AND 1809.    245
 diseases that have been mentioned.  Even the few remedies
 that have been suggested by the author of these inquiries,
 owe their adoption and usefulness chiefly to the influence
 of those two respectable and popular physicians.
   Before I dismiss this part of our subject, I have  only
 to add, that since the cure and extraction of the teeth have
 become a distinct branch of the profession of medicine,
 several diseases which have arisen from them, when de-
 cayed, have been detected and cured.*
   We have thus taken a comparative view of the medical
 theories and remedies of former and modern  times, and
 of their different influence upon human life.   To exhibit
 the advantages of the latter over the former, I shall men-
 tion the difference in the number of deaths in three suc-
 cessive years, at a time when the population  of the city
 and suburbs was supposed to amount to 30,000 souls,
 and in three years,  after the population exceeded double
 that number.
   Between the 25th of December, 1771, and the 25th
 Of December,  1772, there died 1291 persons.
   Between the same days of the same months,  in 1772
 and 1773, there died 1344 persons.
   Within  the same period of time, between 1773 and
11774, the deaths amounted to 1021, making in all 3,656.
 Iregret that I have not  been able to procure the returns
 of deaths in years prior  to those  which have  been  men-
 tioned.  During the three years that have been  selected,
 no unusual mortal diseases prevailed  in the city.   The
 measels were epidemic in 1771,  but were not more fatal
 than in common years.
   Between the 25th of December, 1799,  and  the 25th of
 December,  1800, there died 1525  persons.
   Between  the same days of the same  months, in the
 years  i801 and 1802, there died 1362 persons.
   Within the same  period of time,  between 1802 and
 1803,  the deaths amounted to 1796, making in all 4,883.
   Upon these returns it will be proper to remark,' that
Several hundreds of the deaths, in 1802 and 1803, where

 /.?■' o!C|NIr'. ?"dnZ SPencewa» the first regular bred dentist that
settled.in J»biWelphia There  are now .eferal we« educated gentlemen
in the eity of tfcat profcwion.                          6  «^»e» 
 246            STATE OJF MEDICINE,

 from the yellow fever,  and that  many of them were of
 strangers. Of 68 persons, who were interred in theSwedes'
 church-yard alone, one half where of that description  of
 people.  Deducting 500 from both those causes of extra-
 mortality in the three years, between 1799 and 1803,  the
 increase of deaths above what they were in the years 1771
 and 1774 is but  727.   Had diseases continued to be as
 mortal as they were thirty years ago, considering the pre-
 sent state of our population, the number of deaths would
 have been more than 7,312.
   To render the circumstances of the statement of deaths
 that has been given perfectly equal, it will be necessary to
 add, that the measles prevailed in the city, in the year 1802,
 as generally  as they did in 1771.
   From the history that has been given, of the effects of
 the late improvements and discoveries in medicine upon
 human  life, in Philadelphia,  we are  led to appreciate its
 importance  and usefulness.   It has been said, by  its ene-
 mies, to move; but its  motions have been asserted tC be
 only in a circle.   The facts that  have been stated clearly
 prove, that it has moved, and rapidly too, within  the last
 thirty years, in a straight line.
   To encourage and regulate application and enterprize in
 medicine hereafter, let us inquire to what causes  we are
 indebted for the late discoveries and improvements in our
 science,  and for their happy effects in reducing the num-
 ber of deaths so far below  their former proportion to the
 inhabitants of Philadelphia.
   The first  cause I shall mention is  the great physical
 changes which have taken  place  in  the manners of our
 citizens  in favour of health and life.
   A second cause, is the assistance which has been afford-
 ed to the practice  of physic, by the numerous and impor-
 tant discoveries that have lately been made  in anatomy,
 natural history, and chemistry, all of which have been con-
 veyed, from time to time, to the physicians of the city, by
 means of the Philadelphia and hospital libraries, and by the
 lectures upon those branches of science which are annually
 delivered in the university of Pennsylvania.
  3. The rejection of the supposed healing powers of na-
 ture in all diseases of great, and feeble morbid  action,
and the preference which is given to the more prompt, and 
       BETWEEN 1760 AND 1766, AND 1809.     247

safe method of curing them by means of artificial reme-
dies, have added very much to the utility and credit of
medicine in our city.
  4. The application of reasoning to our science has con-
tributed greatly to extend its success  in the cure of dis-
eases.  Simply to observe and to remember, are the hum -
blestoperations of the human mind. Brutes do both. But
to4Km*ize, that is, to think, or in other language, to com-
pare facts,  to reject counterfeits, to dissolve the seeming
affinity of such as are not true, to combine those that are
related, though found in remote situations from each other,
and, finally, to deduce practical and useful inferences from
them, are the high prerogatives and interest of man, in all
his intellectual pursuit, and in none more than in the pro-
fession of medicine.
  5. The accommodation of remedies to the changes which
are induced in diseases by the late revolutions in our cli-
mate, seasons,  and manners, has had a sensible influence
in improving the practice of medicine in our city.   The
same diseases, like the descendants of the same families,
lose their resemblance to each other by the  lapse of time;
and the almanacks of 1803 might as well be consulted to
inform us of the monthly phases of the moon of the pre-
sent year, as the experience of former years, or the books
of foreign countries, be relied upon to regulate the practice
of physic at the present time, in any  of the cities of the
United States.
  6. From the diffusion of medical knowledge among all
classes of our citizens, by means of medical publications,
and controversies, many people have been taught so much
of the principles and practice of physic, as to be able tQ
prescribe for themselves in the forming state of acute dis-
eases, and  thereby to prevent their fatal  termination.  It
is to this self-acquired knowledge  among the citizens of
Philadelphia, that physicians are in part indebted for not
being called out of their beds so frequently as in former
years.   There are few people who do not venture to ad-
minister laudanum in bowel complaints, and there are some
persons in the city, who have cured the cynanche trachealis
when it has occurred in the night, by vomits and bleeding,
without the advice of a physician.   The disuse of suppers 
34a
STATE OF MEDICINE,
is another cause why physicians enjoy more rest at night
than formerly, for many of their midnight calls, were to
relieve diseases brought on by that superfluous meal.
  7. The dispensary  instituted in our city, in  the year
1786, for the medical relief of the poor, has assisted very
much in promoting the empire of medicine over disease
and death.   Some lives have likewise been saved by the
exertions of the humane society, by means of their printed
directions to prevent sudden death; also, by the medical
services which have lately been extended to our patients,
by order of the managers of the Pennsylvania hospital.
  8thly and lastly.   A change, favourable to successful
practice in Philadelphia, has taken place in the conduct of
physicians to their patients.   A sick room has ceased to
be the theatre of imposture in dress and manners, and pre-
scriptions are no longer delivered with the pomp and au-
thority of edicts.   On the contrary, sick people are now
instructed in the nature of their diseases, and informed of
the  names and design of their medicines, by which means
faith and reasofr are made to co-operate in adding effica-
cy to them. Hor patients left, as formerly, by their phy-
sicians, under the usual appearances of dissolution, with-
out the  aid of medicine.   By thus disputing every inch
of ground with death, many persons have  been rescued
from the grave, and lived years afterwards, monuments of
the  power of the healing art.
  From a review of what has been effected within the last
nine and thirty  years,  in lessening the mortality  of many
diseases, we are led to look forward with confidence and
pleasure to the  future achievments of our science.
  Could we lift the curtain of time which  separates the
year 1847 from our view, we should  see  cancers, pul-
monary consumptions, apoplexies, palsies, epilepsy  and
hydrophobia  struck out of the list of mortal  diseases,
and many  others which still retain an  occasional pow-
er over  life,  rendered perfectly harmless, provided the
same number of discoveries and improvements  shall be
made in medicine in the intermediate years, that have been
made since the year 1766.
  But in vain will the avenues of death from those dis-
eases be closed, while the more deadly yellow fever is per-
mitted  to  supply their place, and to spread terror, dis- 
        BETWEEN 1760 AND  1766, AND 1809.     249

tress, and poverty through the city, by destroying the lives
of her citizens by hundreds or thousands every year. Dear
cradle ot liberty of conscience in the western world ! nurse
of industry and arts ! and patron of pious and benevolent
institutions !  may this cease to be thy melancholy desti-
ny !  may Heaven dispel the errors and prejudices of thy
citizens  upon  the  cause and  means of preventing their
pestilential calamities ! and may thy prosperity and hap-
pinesss be revived, extended, and perpetuated for ages yet
to come!
vol. iv.
i i 
s
4 
INDEX.
                                   A.

AIR, the primary stimulus of life
Adam, the first motions of life in him from the stimulus of air
Actions originally involuntary, become voluntary from habit
Actions  which become voluntary from  habit again  become
     luntary      ......
Arsenic, an account of its use in cancers
Age, an account of the state of the body and mind in old
Circumstances which favour longevity   -
Phacnomena which occurs in the body and mind in old age
Diseases of old age      .....
Of the remedies tor them        ....
Autumn, account of it in Pennsylvania   ...
Air, cold and dry, when proper in pulmonary consumption
Air, cool and cold, advised in the gout  -      -       -
Arteries, facts in support of tneir muscularity and irritability
Arteriotomy, when necessary   -
Its advantages   -      -       -      -
Vol. Page.
        8
      ibid
        10

   i.  ibid
   i.  217
   i.  235
   i.  ibid
   i.  239
   i.  246
   i.  247
   ii.    18
   ii.    74
   ii.  168
  iii-    7
  iv.  124
  ir.  ibid
B.
Barometer, its mean elevation in Pennsylvania  -
Bleeding, when proper in pulmonary consumption
—----, advised in inflammatory gout -
■    ----, in hydrophobia
--------, used in the yellow fever of 1793
Blood not putrid in fevers      ...
-----, appearances of it after bleeding in  1793  -
Bleeding, its salutary effects in the fever of 1793
Circumstances which regulated its use  -
Objections to it answered       -
Blisters useful in the fever of 1793
Bark hurtful in it, and in the yellow fever of 1794
Bowtls, complaints of, in 18u8, and their cause -
Blood-let i in.^, a defence of it   ...
What circumstances indicate it -
Its salutary effects       ....
Objections to it answered       ...
Its advantages over all other depleting remedies  -
Circumstances which regulate its  use
Appearances of the blood to be attended to in  advising it
It is animated by the stimulus of disease
The quantity of it which may be drawn with  safety,
It is rapidly  produced    ....
Bleeding useful  in pregnancy
----.----useful in parturition
ii.	23
ii-	69
ii.	163
ii.	201
iii.	141
iii-	70
iii-	142
iii.	143
iii.	145
iii-	149
iii-	157
iii.	161
iv.	102
iv.	J 73
iv.	ibid
iv.	174
iv.	178
iv.	194
iv.	196
iv.	202
iv.	2U3
iv.	148
iv.	151
iv.	218
IT.	219
 
                               INDEX.
                                4
Bleeding during the cessation of tlie menses
■      — in the disease from taking an excessive dose of opium
--------in the diabetes  .....
--------in chronic intermittents        ...
—------ in dislocated bone3     .
Baths, warm and cold, when established in Philadelphia
ol. Page	
iv.	S2i
iv.	222
iv.	ibid
iv.	223
iv.	ibid
iv.	236
c.
Climate of Pennsylvania, history of     •      -
      - its changes     ...      ...
Cold, its greatest degrees in Pennsylvania      ...
Consumption, pulmonary, thoughts upon
Inquiry into its causes and cure  -----
Its pred;sposing cause   ------
It is  a disease of the whole system      ....
It is  more common among women than men
It in  not contagious     .-.-..
Its supposed causes, proved to be its effects   -
Its premonitory signs    -      -      -
Its cure   -       -      -
Trachea diseased in it   -
Anomalous symptoms described in it   -
Divided into inflammatory, hectic, and typhus states
Remedies for its inflammatory state    ....
Blood-letting     ...-.-.
Vegetable diet    .......
Vomits    -      -  '    -      -  •    -
Nitre, and cold and dry air     .....
For  its hectic state      ......
For  its typhus state     ......
Cough in consumption, remedies for    ....
------for diarrhoea, remedies for        ....
Remedies radical for    ..---.
Signs of a favourable and unfavourable issue of the disease
Cynanche trachealis, observations on    -
History of its symptoms        .....
Its remedies      .......
Colera infantum described
Its supposed causes     -      -
Its real causes    .......
Its remedies      ----...
Means of preventing it   ----..
College of physicians, their address to the citizens of Philadelphia
Air, inflammatory and  malignant       ....
Convalescence from the yellow fever of 1793, its symptoms
Causes which rendered  it mortal         -      -      -      .
Cupping, when indicated and  most proper     ...
Clubs common in Philadelphia between  1760 and 1766 -
Convulsions within that period in pregnancy fatal
ii.	3
ii.	9
ii.	17
ii.	37
ii.	49
ii-	50
ii.	51
iv.	238
ii.	57
ii.	60
ii.	63
ii.	ibid
ii.	61
ii.	65
ii.	66
ii.	69
ii.	ibid
ii.	73
ii.	ibid
ii.	74
ii.	74
ii.	75
ii.	81
ii.	88
ii.	89
ii.	97
ii.	225
ii.	ibid
ii.	226
ii.	215
ii.	217
ii.	ibid
ii.	218
ii.	220
ii.	52
iv.	159
iii	156
iii.	166
iv.	212
iv.	239
iv.  231
D.
Death, how produced           ...
Diseases of the military hospitals, observations on
Diseases, when and how produced  in Pennsylvania
Debility, the predisposing cause of consumption
Diet, vegetable, when proper in it
Diarrhoea, how relieved in it
• i.	48
l.	147
u.	24
u.	60
n.	73
U.	88
 
                               INDEX.

 Dropsy, observations on                             ?
 Its causes       -             .             ...
 Proofs  of inflammatory action in dropsy       ...
 Its remedies    .......
 Bleeding               ......
 Vomits and purges     ......
 Nitre           .......
 Cremor Tartar and Foxglove          -      .      -      .
 Hard labour    ---....
 Low diet, thirst, and fasting           -
 Fear    ---.....
 Recumbent posture of the body and punctures
*Of atonic dropsies     ......
 Reflections upon the  opinions and practice delivered in the
     observations upon dropsies        -
 Debility, the predisposing cause of general fever
 Debility from action, and abstraction described
 Diseases, its unity and six primary forms
 Diet recommended to prevent the yellow fever
 Diseases of 1806, 1807,  1809, account  of
 Diseases, summer and autumnal, inquiry into its causes
 Enumeration  of them        -
 Varied by circumstances     -       .      -      -      -
 Its different forms     ......
 Means of preventing it       -
 Its premonitory signs         -
 Means of peventing its mild grades
 Also its intestinal state       .....
 Means of defending from its remote causes
 Means of extirpating its remote causes
 Insufficiency of quarantines for that purpose, and their evils
 Diabetes, bleeding useful in          -
 Diseases in Philadelphia between 1760  and 1766


                                   E.

 Epidemics, one «f its laws           -                           ;",;.  216
 Exercise, its different modes         -                           ii.   90
                                    F.

Faculty, moral, inquiry into the influence of physical causes on
Moral faculty defined         -      -      .       .      .
------it is innate     ---...
Influence of climate and diet upon it   -
Of certain drinks      -             ....
Of hunger             -      -             .
Of dfseases      ----...
Of idleness      ---....
Of excessive sleep     --....
Of cleanliness         --.-..
Of solitude     ---....
Of silence      ---....
Of music       ---.-..
Of the eloquence of the pulpit        ....
Of odours      ----...
Of airs         ----...
Of medicines         ---...
Means of improving moral feeling     -
Of lessening it                ......
Vol. Page.	
ii.	10S
ii.	104
ii.	105
ii.	106
ii.	M7
ii.	ibid
ii.	109
ii.	ibid
ii.	110
ii.	HI
ii.	112
ii.	114
ii.	112
ii.	120*
iii.	3
iii.	ib:
iii*	11
ii.	160
iv.	101
iv.	107
iv.	ibid
iv.	110
iv.	ibid
iv.	112
iv.	ibid
iv.	127
iv.	128
iv.	132
iv.	133
iv.	137
iv.	222
iv.	229
 95
ibid
 97
108
107
108
109
ibid
110
HI
ibid
117
112
113
ibid
114
ibid
116
 118 
INDEX".
 Fever, bilious, remitting of 1780 described
 Its remedies           ...
 Fever, phenomenon of, described
 Its predisposing and remote causes
 Its unity         ....
 Consists in convulsions of the blood  vessels
 Its symptoms    -
 Its morbid effects       -       -      -
 Its different states      -
 Malignant       -
 Gangrenous      -
 Synochus fortis   -      -       -      .
 Synocha         -
 Synochula       -      -       -      .
 Synochoid      -      -       -      .
 Synochus mitis   -
 Typhus          -
 Typhoid        -
 Hectic          -
 Intermitting      -
 Febricula        -
 Sweating        -
 Fainting        -
 Burning         -      -       -      .
 Cold and chilly   -      -       -      .
 Intestinal        -      -       -      .
 Pulmonary       -      -       -      .
 Eruptive         -
 Anginose        -      -       -      .
 Rheumatic       -
 Arthrictic       -
 Cephalic        -
 Nephritic
 Hydrophic      -      -       -      .
 Hemorrhagic   -
 Amenorhagic    ....
 Misplaced seats of fever -
 Chronic hepatic state of fever
 Haemorrhoidal   -
 Ophthalmic      ....
 Odantalgic      ....
 Otalgia'         ....
 Apthorus        ....
 Scrophulous     -
 Scorbutic        ....
 Convulsive or spasmodic
 Hysterical and hypochondriacal  -
 Cutaneous       ....
 Fever, bilious yellow, in Philadelphia of 1793
 Its remote cause        ...
Its exciting causes      ...
Its premonitory signs    ...
Its symptoms     ....
 In the blood-vessels     ...
In the liver, lungs and brain
Jn the stomach and  bowels
In the secretions and excretions
In the nervous system
In the senses and appetite
In the lymphatic and glandular system -
Upon the skin 
                              INDEX.

Its remissions and intermissions       ....
Its division into three grades           ....
Its predominance over all other disease       ...
Who were chiefly affected by it
Who were exempted from it           ....
Symptoms of infection before patients were confined by it
State of the weather during its  prevalence     ...
It is taken twice by several persons           ...
Appearances of the body after death, both external and internal
Dsitress of the city                          ...
A list of the deaths in August, September and October
The cessation of the disease                  ...
Checked by wet and cold weather
Its origin           -                        ...
Method of cure         -             ....
Unsuccessful issue of stimulants       -
Of the use of calomel and jalap as a purge    ...
Of purging generally          -
Its salutary effects             .....
Objections to purging with  calomel and jalap answered
Of blood-letting in  the cure of  the fever of 1793, and reasons for it  iii
Appearances of the blood             ...
Its salutaray effects      -            ...
Circumstances which regulated its use
Objections to  it answered              ...
Cold water, its advantages in this fever
Salivation, its efficacy   -             ...
Causes of the occasional failure of the above remedies
Comparative view of their success with other  remedies
Fever yellow, of  1794, described       ...
Its predisposing causes         -
Its symptoms                  ....
In the blood-vessels           ....
In the liver          -        ....
In the alimentary canal         ....
In the secretions  and excretions       ...
In the nervous system         ....
In the senses  and appetites     ....
In the  lymphatic system       ....
Upon the skin          .....
In the blood            .....
The different forms of this fever       ...
Its critical days obvious        ....
Combines with other diseases   ....
Its origin                     ....
Method  of cure               ....
By  bleeding                   ....
Appearances of the blood      ....
By purging                   ....
By cold  air, cold drinks, and cold water applied to the body
By salivation                  ....
Comparative view of the success of the different modes of practice
     in the fever of 1794       ....
Superiority of the North American mode
Fever, bilious yellow of 1795 and 1796, sporadic cases of
     , of  17'J7, account of       ....
Its predisposing causes and premonitory signs
Its symptoms in the blood-vessels
In the  alimentary canal         ....
In the nervous system         ....
Vol.	Page.
iii.	73
iii.	74
iii.	77
iii.	79
iii.	80
iii.	84
iii.	86
iii.	88
iii.	89
iii.	91
iii.	97
iii.	98
iii.	101
iii.	106
iii.	125
iii.	126
iii.	129
iii.	133
iii.	135
iii.	140
it iii.	141
iii.	142
iii.	143
iii	147
iii.	149
iii.	155
iii.	157
iii.	166
iii.	169
iii.	197
iii-	202
iii.	203
iii.	ibid
iii-	204
iii.	205
iii.	206
iii.	208
iii.	210
iii.	211
iii.	laid
iii.	212
iii.	213
iii.	215
iii.	'214
iii.	217
iii.	220
iii.	ibid
iii.	222
iii.	223
iii.	224
iii.	225
ce iii.	233
iii.	236
iii.	241
iv.	3
iv.	9
iv.	10
iv.	ib.
iv.	11
 
                                 INDEX.

 In the senses           .....
 In the glands          .....
 Upon the skin          ......
 In the blood            -
 Its types               .....
 Its different states      .....
 Cases of its being taken a second time
 Its mortality           .....
 Its origin              .....
 Its remedies           .....
 Bleeding               .....
 Purging               ,.       .       .       .       .
 Salivation        .......
 Different modes in which mercury acted
 Emetics        ...       ...
 Diet and drinks       .....
 Cold applications  to the body           -
 Blisters         -.....,
 The relative effects of different  modes of practice
 Favourable signs        ......
 Unfavourable signs      ......
 Fever, yellow, of  the year 1798, account of
 Its symptoms in the different systems          -      -      .
 Its -xciting causes     ......
 Manner in which  t terminated ..tally
 Su ;  of the body as exhibited alter death by dissection
 Its oiigin       ----...
 Its remedies    ----...
 Emetics, their good effects     -       -      -      .      .
 Purges, salivation, and bleeding        -      -      .      .
 Blis ers         .......
 Favourable and  unfavourable signs     ....
 Results of different modes of practice in this fever
 Fever, yellow, of 1799, an account of         -
 Its premonitory  signs           -      -       -      -      .
 Its symptoms in the different systems
 Its remedies    -----..
 Sporadic cases in 1800 and 1801        -       -      .      .
 Fever, yellow, as it appeared in 1802
 Fever, yellow, sporadic cases of in 1804
 ----ditto in 1805       ...       ...
 ----of their origin     ......
 Fever, yellow, sporadic cases of in 1806,1807, 1809
 —— not contagious            -
 ----distinguished from the jail fever
Proofs of the yellow fever being an atmospherical disease
Objections to this opinion answered     -
—— 1S rendered malignant by a peculiar constitution of the air
A  belief in its contagiousness superstitious
c.
Gout, observations on
Is a disease of the solids
Who are most subject to it
Its remote causes
Its exciting causes
Its seats
Remedies for it
Bleeding-
Vol.	Page.
iv	12
iv	ib.
iv,	ib.
iv,	12
iv	13
iv.	ib.
iv,	17
iv,	18
iv.	20
iv.	ib.
iv.	ib.
iv.	22
iv.	23
iv.	24
iv.	26
iv.	27
iv.	28
iv.	29
iv.	31
iv.	32
	
iv.	jj
iv.	39
iv.	40
iv.	43
iv.	ib.
iv.	44
iv.	45
iv.	ib
iv.	46
iv.	47
iv.	48
iv.	ib.
iv.	49
iv.	55
iv.	56
iv.	57
iv.	58
iv.	63
iv.	69
iv.	91
iv.	95
iv.	ib.
iv.	101
iv.	143
iv.	ibid
iv.	152
iv.	155
iv.	159
iv.	170
ii.	147
ii.	ibid
ii.	ibid
ii.	148
ii.	150
ii.	ibid
ii.	161
ii.	164
 
                              INDEX.
                                                             Vol. Page
Ks salutary effects       -          .....     ii.   166
Vomits          -       -      -      .      .                   ji.   167
Nitre......       .      ii.  168
Cool and cold air        -      -      -       .       .       -      ii.  ibid
Diluting  liquors       '-      -      -       .       -       .      ii.  169
Abstinence       -       -                                        ii.  , bid
Blisters,  fear and terror        -      -                           ii.  ibid
Other volatiles, aromatics, and oil of amber    -       -       -      ii.  173
Warm bath and a salivation    -      -       -       -       -      ii.  ."4
Frictions        .......      ii.  ,! id
Remedies for symptoms        -      -       -       -       -      ii.  ibid
Head-ach       .......      ii.   175
Opthalmia      .......      ii.   176"
Pains in the limbs      ......      ji.  ibid
Diarrahoea, angina pectoris, spasms in  the stomach, and pains in the
    bowels             -                                        ii.  "ibid
Pain in the rectum      ......      ii.   177
Pxeternatural secretion  and excretion of bile,  and  itching  of the
    anus and vagina                 , -       -       -             ii.  ibid
Eruptions       -     -       .....      ii.  ibid
Gonorrhoea      -      -       - -     -       -       -             ii.   178
Gout, a curable disease        1      -       -       -       -      ii.   179
Means of preventing the return of its inflammatory paroxysms       ii.   180
Means of preventing the  return of paroxysms of feeble morbid ac-
    tion        -       ------      ii.   185
Summary of opinions defended in the observations upon the gout    ii.   188

                                  H.

Heat, its  greatest degree in Philadelphia       -       -      -
Its medium  temperature in    -       -       -       -„      -
Hail, account ol a storm        -       .       .
Heat,  its medium temperature during the prevalence of the yellow
    fever in Philadelphia      .....
Hymoptysis, remedies for      .....
Hydrocephalus interims described      ....
Its causes
Water in the brain is the effects of  previous morbid action and in
    flammation        ......
Its remedies           -      -      ...
Bleeding       -      -      -
Purges         -      -      -'-       -       -*»-
Blisters  and Mercury          -      -       .       -       .
Cold applications to the head          -
Hydrophobia, observations on          ....
Its causes    ~  -
Its grades       .......
Is a state of fever       ......
Means of preventing it         .....
-ii.	11
11.	ib.
11.	14
i.	90
IV.	31
IV.	129
iv.	133
iv.	136
IV.	138
IV.	ibid
IV.	146
IV.	ibid
IV.	147
IV.	193
IV.	194
IV.	196
IV.	197
IV.	222
                                  I.

Infancy, life first excited in it by air    -
Indians, oration  on the statement of medicine among them
Of the birth and treatment of their children
Of the diet of the Indians      -      -      -      -
Of the custom peculiar to each sex     -      -
Of the customs common to both sexes
Their diseases         .....
10
58
59
ib.
60
61
63 
                              INDEX.
                                                             Vol. Page.
Their remedies         -       -       -      -      -      -      i.    66
A comparative view of their diseases and remedies with those of
    civilized nations    -       -       -       -       -             i-    72
Of their diseases       -       -       -      -      -      -      i.    ib.
Of the powers of nature in curing them       -      -      -      i.    74
Of the remedies of civilized nations     -      -      -      -      i.    79
June described in Pennsylvania        -      -      -      -      i.    14
A healthy month               -----      i.    29
Influenza, account of as it appeared in Philadelphia in the autumn of
    1789, in the spring of 1790, and in the winter of 1791     -      ii.   265
------account of it  in Philadelphia in 1789, 1790,1791, also in 1807  iv.   101
Importation of the yellow fever impossible      -      -      -     iv.   16t
Benefits to be derived from  this opinion        -      . -      -     iv.   166
Intermittents chronic, bleeding useful in them         -       -     iv.   169

                                  L.

Life, animal  ■-.---..
——consists in heat, motion, sensation, and thought
----is an effect of stimuli        .....
    originally  ^voluntary        .....
Of external stimuli              .....
Particularly air          --....
Of internal  stimuli       ......
Life, animal, how supported in sleep     ....
In the foetus in utero     ......
In infancy and childhood  -      -      ....
In youth
In middle life     .......
In old age        -----..
In persons blind and deaf from their birth       -      -      -
In apparent death        ......
In Indians of northern latitudes
In the inhabitants of the torrid regions
In cold countries        --.-..
In enslaved countries           .....
Stimuli which act upon the whr>le human species
Stimuli which act upon all the specie^ of animals
Inferences from the doctrine of life delivered
Death, how produced
Legs sore, an inquiry into their cause and cure  -
Labour advised in the consumption      ....
Leeches, when indicated, and most proper     ...
By whom introduced into general use in Philadelphia
                                 M.

Matter animated and inanimated alike, in being moved only by stimuli i.
Medicine, means of improving it       ....
Measles, account of in Philadelphia in 1789    ...
Of the external measles         -
Miasmata, signs of their presence in the body
Mc>; n, its Influence upon the mortality of the fever of 1797
Measles, epidemic in           .....
Menses, bleeding about the time of their cessation
Medicine, the state of, between  1760 and 1766, and compared with
    its state in 1809            -      -      -      .      .
Medicine, different systtms'in Philadelphia
Midwifery, improvements in Philadelphia since 1766
  7
 10
  8
 ib.
 14
 20
 24
 25
 27
 ib.
 ib.
 29
 32
 36
 37
 ib.
 38
 40
 44
 46
 48
225
 96
212
240
ii.	5
i.	270
ii.	255
ii.	269
iii.	217
iv.	17
iv.	102
iv.	221
iv.	288
iv.	240
iv.	243
 
INDEX.
Mortality of diseases discovered in Philadelphia since 1766
The reason of it
Vol. Page.
  iv.   245
  iv.   133
                                  N.

Nosology, objections to it     -                                 iii.   19
Narrative of the state of the author's body and mind during the pre-
    valence of the yellow fever in  1793       -      -      -      iv.  197
Nature much confined in Philadelphia between 1760 and 1766      iv.  396
Statement of her powers      -                                   i.  227

                                  0.

Omentum supplies the matter for the production of chyle and blood
    through  the medium of the liver         -      .       .       iv. '207
Opium, bleeding useful in the disease created by an excessive dose of iv-  222

                                  P.
Physicians, the duties of
Pennsylvania, its climate      ...
Its extent and boundaries      ...
Us rivers       .....
Its mountains          -
Its soil         -      -      .      . ,    .
Philadelphia, its situation
Its population in 1809
Phithisis trachealis described  -
Preventives of yellow fever
Pulse, its different states described in fevers
----, how to be felt    ....
Pregnancy, bleeding useful in
Also in parturition     ....
Poisons, bleeding useful in obviating their effects
i. ii.	257 5
i.	ib.
i.	ib.
i.	6
i.	7
l.	8
l.	ib.
i.	57
HI.	177
IV.	19S
IV.	210
IV.	218
iv.	219
iv.  220
Q.
Quarantines, their folly and evil^
iv.  127
                                 R.

Revolution, American, its influence upon the human body
Rain, tne quantity which falls annually in Pennsylvania
Riding on horseback, its good effects in plumonary consumption

                                 S.
121
 23
 91
Stimuli, their effects in the production of life
Spirits, ardent, their influence upon the body and mind
Drunkenness produced by them, described
Diseases induced by them
Their effects upon the mind
Aliments in their favour refuted      «      .  .
■^ubsahites for them    -
...uiitions against their use, to certain classes of people
  8
15,1
ibid
157
158
160
161
164 
INDEX.
Vol.
 Remedies for a fit of drunkenness
 ----for the habitual use of spirits
 Spring, account of in Pennsylvania
 Summer,  a dry one described
      i, a wet one described
 Storms in Pennsylvania not uncommon
 Salt, common, its efficacy in homoptysis
 Sea voyages when proper in consumption
 Scarlatina anginosa described
      • its remedies
 Means of preventing it
 Salivation, its efficacy in the fever of 1793
 —-----,  its efficacy in the fever of 1794
Different modes in which mercury acts during a salivation    -      iii.
 A salivation excited and  checked by cold water      - •      -      iii.
 Surgery, improvements in Philadelphia since 1766           -      iii.

                                 T.
Teeth, when decayed, the causes of several diseases   -       -        i.
Tastes and aliments, their relation to each other      -       -        i.
Tetanus, observations on                                          i.
Its causes  from wounds       -       -       -       -               i.
From other causes     ....--        i.
Its causes in infants    -      -       -       -       -       -        i.
Its remedies    .......        i.
Thaw, a remarkable one  in Pennsylvania      ...       ii.
Tubercles in the lungs, the effects, and not the cause of consumptions ii.
Travelling advised in them     .  ,     -       .      .      -       ii.
Turpentine, spirit of, useful to check  the vomiting in the yellow
    fever       .......       iv.
Page.
  170
  172
   18
   24
   ib.
   25
   31
,   90
.  243
  246
  250
  157
  225
■   23
  225
  227
199
 14
179
180
ibid
183
186
 15
 60
 91

 96
                                    u.

Ulcers in the lungs, the effects, and not the cause of pulmonary con-
    sumption         ......        ii.  167
Vomiting, means of checking it in the yellow fever         -        iv.   48
<——*----also         ......        iii.  ] 58

                                 W.
Water, cold, the disease induced by drinking it described   -        i-  193
Its remedies           ......        j. ibid
Worms in the alimentary canal        ....        i. 205
Observations on        ......        i. ibid
Remedies for them     -      -       ...       .       .        i. 209
They act chemically and mechanically        -       -       -        i. 211
Weather variable in Pennsylvania      -       -       -       -       ii.   14
Winter in Pennsylvania discribed      -       -       -       T       ii. 155
Weather, thermometrical account of in 1793         -       -      iii. 120
Winds in the spring, their influence upon the healthiness of the
    autumn    --.-...        iii.  gg 
 
(
^O
3f





rv 
 Medical Inquiries, v. 3-4. Fifth Edition
 Rush, Benjamin
 Philadelphia: 1819
 National Library of Medicine
 Bethesda, MD

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